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Long-Term Efficacy and Outcomes of Endovascular Interventions in Budd-Chiari Syndrome-A Real World Analysis

Amar Mukund1, Vaibhav Thakur1, Ankur Jindal1

  • 1Institute of Liver and Biliary Sciences, New Delhi, India.

Liver International : Official Journal of the International Association for the Study of the Liver
|April 8, 2026
PubMed

Insights

Endovascular interventions like hepatic vein recanalization and Direct Intrahepatic Portosystemic Shunt (DIPS) effectively manage Budd-Chiari Syndrome (BCS). Hepatic vein recanalization offers superior long-term patency and fewer repeat procedures compared to DIPS.

Area of Science:

  • Interventional Radiology
  • Hepatology
  • Vascular Surgery

Background:

  • Budd-Chiari Syndrome (BCS) is a rare condition characterized by hepatic venous outflow obstruction.
  • Endovascular interventions are crucial for managing BCS, aiming to restore liver blood flow and improve patient outcomes.
  • Evaluating the long-term efficacy and safety of different endovascular techniques is essential for optimizing BCS treatment strategies.

Purpose of the Study:

  • To assess the long-term safety, efficacy, and clinical outcomes of endovascular interventions in Budd-Chiari Syndrome (BCS) patients.
  • To compare the outcomes of hepatic vein/inferior vena cava recanalization with Direct Intrahepatic Portosystemic Shunt (DIPS) procedures.
  • To determine the patency rates and survival outcomes associated with these endovascular approaches in BCS.

Main Methods:

  • Retrospective analysis of electronic medical records for BCS patients undergoing endovascular interventions from 2010 to 2022.
  • Inclusion criteria required at least two years of follow-up.
  • Analysis of laboratory parameters, clinical outcomes (ascites, rebleeding), intervention types, patency rates, and survival rates.

Main Results:

  • 161 BCS patients underwent endovascular interventions: 103 with hepatic vein/inferior vena cava recanalization and 58 with DIPS.
  • Both interventions significantly improved clinical outcomes and ALBI grades (p < 0.01).
  • Hepatic vein recanalization showed higher patency rates (96% at 1 year, 92% at 5 years) and required fewer repeat interventions (7.7%) compared to DIPS (82% and 45% patency, 58.6% repeat interventions). 10-year survival was 92% for recanalization and 88% for DIPS.

Conclusions:

  • Endovascular interventions are effective in resolving symptoms and providing excellent long-term survival for BCS patients.
  • Hepatic vein/inferior vena cava recanalization demonstrates superior long-term patency and a lower need for repeat procedures compared to DIPS.
  • DIPS is associated with higher baseline disease severity scores and a greater requirement for re-intervention, indicating its use in more complex BCS cases.
Abstract

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