3:54 PM Abstract No. 48 - Percutaneous interventional strategies for management of Budd-Chiari syndrome (BCS) in pediatric patients

Abstract

Purpose Analysis of technical success,complications,primary patency and need for reintervention in percutaneous management of BCS. Materials and Methods Study was undertaken from august 2009 to august 2012. Inclusion criterion was patients with features of primary and secondary BCS. Those excluded were ones unwilling for follow up or refusing to give informed consent. Out of total of 24 patients, 18 (75%) and 6 (25%) were males and females respectively with age range of 4-17 years. Diagnosis of BCS was based on doppler sonography showing obstruction of supra/retro hepatic IVC and/or hepatic veins. Technique for intervention and route of access was selected on the basis of extent and type of hepatic vein(HV)/IVC block. Post procedure, patients were maintained on oral anticoagulation with target INR of 2.5-3.5 with regular six monthly clinical, biochemical and doppler followup for upto 36 months. Results Interventional procedures performed included angioplasty (2 cases), stenting of right HV, middle HV and accessory HV in 6,15 and 1 case respectively. HV cannulation failed in 1 case. Complications encountered included minimal hemoperitoneum (2 cases), sub capsular hematoma and minimal hemothorax (1 case each). 30 days mortality was not encountered. Technical success of hepatic vein stenting was 95.8%. Outcome over 30 days follow up included normal stent flow in 22 cases, needing reintervention in 1 case while 1 case was lost to followup. Follow-up at 1 year included maintained doppler flow, reintervention performed and loss to follow-up in 21, 2 and 1 case respectively. Follow up at 2 years showed maintained doppler flow, reintervention performed and death due to underlying heart disease in 13, 1 and 1 case respectively. Follow-up at 3 years showed maintained doppler flow, reintervention done and loss to follow up in 5,2 and 1 case respectively. Conclusion Percutaneous intervention should be considered as useful and less invasive interventional treatment alternative for management of hepatic venous outflow obstruction. Technical success, outcome and stent patency in the present study was comparable to other published data pertaining to interventional management of BCS.