Budd-Chiari Syndrome: Recanalization of an Occluded Hepatic Vein with Percutaneous Transluminal Angioplasty and a Metallic Stent

Abstract

From the First Department of Internal Medicine, Faculty of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyouku, Kyoto 606 Japan. Received May 19, 1992; revision requested June 12; revision received October 9; accepted November 2. Address reprint requests to M.F. SCVIR, 1993 B u D D c H m I syndrome is a type of portal hypertension with the clinical triad of hepatomegaly, ascites, and right upper quadrant pain. It is caused by obstruction to the hepatic venous outflow, and it consists of acute and chronic forms (1,2). The site and extent of the obstructed lesion are variable. In the Orient, Budd-Chiari syndrome secondary to obstruction of the hepatic ort ti on of the inferior vena cava (IVC) has been commonly reported (1-6); in Japan, membranous obstruction of the vena cava appears to account for approximately 80% of cases (4-6). In the West, most cases are due to thrombotic occlusions of the hepatic veins, which are frequently associated with hypercoagulable states, most commonly including polycythemia Vera and the use of oral contraceptives (1,2,7). We describe a patient with extensive thrombotic occlusion of the IVC and the major hepatic veins. In this patient, hepatic encephalopathy due to the hepatofugal portal flow occurred several times. To relieve obstruction of the hepatic venous outflow, we recanalized the occluded hepatic vein and placed a tantalum wire mesh stent by means of a percutaneous transhepatic approach.