Hepatic vein stenting for Budd-Chiari syndrome
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Published on: March 25, 2022
A M Witte1, L J Kool, R Veenendaal
1Department of Gastroenterology, University Hospital Leiden, The Netherlands.
Insights
Hepatic vein stenting effectively treated Budd-Chiari syndrome with ascites in two patients. This minimally invasive procedure relieved venous outflow obstruction, resolving ascites and reducing diuretic needs.
Area of Science:
- Interventional Cardiology
- Hepatology
- Vascular Surgery
Background:
- Budd-Chiari syndrome often presents with intractable ascites due to hepatic venous outflow obstruction.
- Severe hepatic vein stenosis and occlusion pose significant therapeutic challenges.
Observation:
- Two patients with Budd-Chiari syndrome and severe hepatic vein stenosis experienced intractable ascites.
- Conventional therapies were insufficient to manage the ascites.
Findings:
- Percutaneous transluminal angioplasty and metallic stenting of the stenotic hepatic vein normalized the pressure gradient.
- Both patients experienced complete resolution of ascites and a significant reduction in diuretic requirements.
Implications:
- Hepatic vein stenting is a feasible and effective treatment for Budd-Chiari syndrome.
- This intervention may help patients avoid or delay the need for shunt surgery or liver transplantation.
Abstract:
This report describes two patients with Budd-Chiari syndrome with intractable ascites due to a tight hepatic vein stenosis while the other hepatic veins were occluded. Percutaneous transluminal angioplasty of the hepatic vein stenosis followed by insertion of expandable metallic stents reduced the pressure gradient across the stenosis to almost zero. In both patients, ascites disappeared and diuretic therapy could be reduced significantly. This treatment has remained effective for more than 1 yr in one case and 2 yr in the other. These cases demonstrate the feasibility of hepatic vein stenting as a therapy for hepatic venous outflow obstruction. This therapy may be used in selected patients to defer and perhaps avoid shunt-surgery or liver transplantation.
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