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Outcomes of Hepatic Venoplasty in Budd-Chiari Syndrome
Adnan Salim1,2,3, Khurram Shafique, Sadia Jabbar
1Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan.
Insights
Hepatic venoplasty offers good long-term outcomes for Budd-Chiari Syndrome (BCS) patients without advanced cirrhosis. Early intervention is crucial, as outcomes worsen with cirrhosis, making liver transplantation the primary curative option.
Area of Science:
- Hepatology
- Interventional Radiology
- Vascular Surgery
Background:
- Budd-Chiari Syndrome (BCS) is a rare condition characterized by hepatic venous outflow obstruction.
- The syndrome can lead to severe liver damage, including cirrhosis and ascites.
- Hepatic venoplasty is a minimally invasive procedure aimed at restoring blood flow in obstructed hepatic veins.
Purpose of the Study:
- To evaluate the medium to long-term efficacy and outcomes of hepatic venoplasty in patients diagnosed with Budd-Chiari Syndrome.
- To assess the impact of pre-existing cirrhosis on the success of venoplasty.
- To determine the optimal timing for intervention in BCS patients.
Main Methods:
- An observational study was conducted involving 25 adult patients with BCS undergoing venoplasty.
- Patients were followed up for 12 months post-procedure.
- Data collected included patient demographics, etiology of BCS, liver disease severity (Child-Pugh score), procedural details (stenting), and post-procedure complications and outcomes.
Main Results:
- Of 25 patients, 18 were male, and 11 had a hypercoagulable state. Cirrhosis was present in 32% of patients.
- Pre-venoplasty, 96% had ascites and 84% had varices. 72% underwent stenting, and all received warfarin.
- At 12 months, 40% had patent hepatic veins; 16% needed liver transplantation, 16% were lost to follow-up, and 24% died from cirrhosis-related complications.
Conclusions:
- Hepatic venoplasty demonstrates favorable long-term outcomes in Budd-Chiari Syndrome patients who have not developed advanced cirrhosis.
- For patients with established cirrhosis, venoplasty outcomes are suboptimal, underscoring liver transplantation as the definitive treatment.
- Early diagnosis and referral to specialized centers before the onset of cirrhosis are critical for improving patient prognosis.
Objective:
To observe medium to long-term outcomes of hepatic venoplasty in patients with Budd-Chiari syndrome (BCS).
Study Design:
An observational study. Place and Duration of the Study: Department of Gastroenterology and Radiology, Shaikh Zayed Hospital, Lahore, Pakistan, from February 2021 to December 2022.
Methodology:
After obtaining ethical approval, adult patients presenting to the authors' Institute with BCS and candidates for venoplasty were recruited. After the procedure, they were followed up for twelve months.
Results:
Twenty-five patients were recruited including 18 (72%) males and 7 (28%) females. Vascular occlusion was due to identified hypercoagulable state in 11 (44%) and idiopathic in 14 (56%). Eight (32%) patients had liver cirrhosis. Ascites was present in 24 (96%) patients prior to venoplasty. Twenty-one (84%) patients had varices. Stage of liver disease was child A in 5 (20%), B in 16 (64%), and C in 4 (16%). Vascular blockage involved all hepatic veins in nearly a quarter of patients. Vascular stenting post-venoplasty was done in 18 (72%). All patients received warfarin (target INR 2-2.5). Twelve months after venoplasty, 4 (16%) patients had undergone liver transplantation, 4 (16%) lost to follow up, and 6 (24%) had expired due to cirrhosis-related complications. In the remaining 11 (44%), hepatic veins were patent in 10 (40%) and blocked in 1 (4%). One (4%) patient had significant ascites, whereas significant-sized varices were noted in 2 (8%).
Conclusion:
Venoplasty results in good long-term outcomes in patients with BCS if they have not developed advanced cirrhosis. In patients with cirrhosis, outcomes are suboptimal and liver transplantation remains the only curative option. This highlights the importance of early detection and specialist centre referral before cirrhosis develops.
Key Words:
Budd-Chiari Syndrome, Venoplasty, Cirrhosis.
