Hepatic vein stenting for Budd-Chiari syndrome

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.