Hepatic Vein Angioplasty Research Articles

Percutaneous transluminal angioplasty for symptomatic hepatic vein-type Budd-Chiari syndrome: feasibility and long-term outcomes

For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)—32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5–70.8; range, 1.2–81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.

Budd chiari syndrome: A case report on a rare disorder

Budd Chiari syndrome (BCS) is a rare disease that threatens life due to a hepatic vein blood flow obstruction. As per the literature, thrombosis is a significant factor for hepatic venous obstruction. It can treat BCS based on the severity of the patient’s condition by three methods like hepatic vein angioplasty, interventional radiology stenting with direct intrahepatic portosystemic shunt, or liver transplantation. We describe the case of a 34-years-old female patient who presented with abdominal distension and generalized weakness with a history of BCS. A cooperative collaboration of hepatologists and interventional radiologists helps in effectively treating the syndrome.

Percutaneous Transhepatic Hepatic Vein Angioplasty in Budd-Chiari Syndrome After Transvenous Failure.

To evaluate the safety and efficacy of percutaneous transhepatic route creation for hepatic vein (HV) angioplasty in Budd-Chiari syndrome (BCS). Between April 2012 and August 2016, a total of 19 BCS patients underwent percutaneous transhepatic route creation for HV angioplasty after transvenous catheterization failure in this study. Color Doppler ultrasonography was required in all patients after admission and during follow-up. Data were retrospectively collected, and follow-up observations were performed. Technical and clinical success was achieved in 18 patients. Except for 1 failure of route creation, 19 routes were successfully created in 18 patients, with a technology success rate of 95.0%. Twenty-two balloon angioplasties were performed in 18 patients, with a mean balloon diameter of 13.6 ± 0.5 mm. Blood pressure and length of occlusive HV decreased significantly, and blood flow velocity and diameter of HV increased significantly after procedure. Abdominal distension/pain and ascites decreased significantly after procedure. One procedure-related death occurred, who died of gastrointestinal bleeding 6 days later. Except for the failure case, the rest of 18 patients were successfully followed up. The remaining 18 patients survived during follow-up, with a 5-year survival rate of 94.9%. One patient had a restenosis of HV after 47 days, and had undergone successful dilation. The 5-year primary and second patency rates were 94.1% and 100%, respectively. Percutaneous transhepatic route creation is safe and effective for HV angioplasty, and can be used to treat BCS patients after transvenous catheterization failure.

Radiological Management of Hepatocellular Carcinoma Associated With Hepatic Venous Outflow Tract Obstruction

Background and Aim: Hepatocellular carcinoma (HCC) associated with hepatic venous outflow tract obstruction (HVOTO) is an unusual entity which has recently gained recognition. Treatment of both entities is essential in prolonging survival. Interventional radiologic techniques are the established therapeutic options for HVOTO and HCC and thus treatment becomes challenging. We illustrate two representative cases treated successfully treated at our centre. Methods: Patients with clinical diagnosis of HVOTO were evaluated by ultrasound Doppler, multiphase CT liver (MPCT)/dynamic MRI. HVOTO was confirmed by the presence of intrahepatic venous obstruction on Doppler and the treatment was based on the site/type of venous obstruction and included inferior vena cava(IVC) angioplasty or hepatic vein angioplasty (both with or without stenting) and trans-jugular intrahepatic port-systemic shunt (TIPS)/direct intrahepatic port-systemic shunt. On MPCT, HCC diagnosis was based on the modified EASL criteria. Staging and treatment options were according to the Barcelona clinic liver cancer (BCLC) staging. Results: Case one was diagnosed with absent all three hepatic veins with BCLC B stage HCC on MPCT and Doppler. TIPS was performed for HVOTO and subsequently TACE was undertaken for HCC. Follow up Doppler confirmed normal flow through the shunt and HCC depicted complete response. Case two was diagnosed with stenosis of all hepatic veins and IVC stenosis at cavo-atrial junction with intrahepatic collaterals. He also had BCLC B stage HCC on MPCT. IVC angioplasty was performed following which there was persistent stenosis on Doppler assessment, IVC stenting was subsequently performed which restored the normal calibre and flow in IVC. TACE was done for HCC and the residual tumor was completed treated by acetic acid ablation. Conclusion: Radiological techniques play a key role in the diagnosis and management of HVOTO-HCC. Both the entities need to be treated and this makes the treatment very challenging. The authors have none to declare.

Budd-Chiari syndrome: outcomes of endovascular intervention-A single-center experience.

Outcomes of endovascular intervention in Budd-Chiari syndrome (BCS) have been reported with varied results. Clinical outcomes of endovascular interventions in BCS and role of various prognostic scores were critically evaluated in this study. This study retrospectively analyzed consecutive patients of BCS who underwent endovascular intervention between January 2007 and May 2016 at our center. Technical, clinical successes and complications were documented. The role of the prognostic scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), Rotterdam index, and original Clichy score in predicting mortality, clinical success, and need for re-interventions were also assessed. A total of 88 patients were analyzed. The median follow up was 12months (range 1-96months). Thirteen (14.8%) patients had combined inferior vena cava (IVC) and hepatic vein (HV) obstruction; HV obstruction in 33 (37.5%) and inferior vena cava IVC obstruction in 42 (47.7%) patients. The following interventions were done: IVC angioplasty alone (n=11), IVC angioplasty with stenting (n=36), HV angioplasty with stenting (n=26), combined HV and IVC stent (n=2), and direct intrahepatic porto-systemic shunt (DIPS) (n=13). Overall technical success was 87/88 (98.86%), and clinical success was 76/88 (86.36%). Immediate complications were noted in 8 patients (10%). The 1-, 2-, 3-, and 4-year stent patency rates were 90.91%, 81.08%, 74.59%, and 70.45%, respectively. Re-interventions were required in 15 (17%). Overall mortality was 6 (6.8%). Apart from MELD >14, none of the other prognostic score could predict mortality, clinical success, and need for re-interventions. Endovascular interventions play an important role in the management of BCS, in properly selected patients, even if prognostic score is unfavorable.

Method and safety analysis of interventional treatment of Budd-Chiari syndrome in 1 246 patients

Objective To analysis the method and safety of interventional treatment of Budd-Chiari syndrome (BCS). Methods The retrospective cross-sectional study was adopted. The clinicopathological data of 1 246 patients with BCS who underwent interventional treatment at the Beijing Shijitan Hospital of Capital Medical University between October 1993 and February 2015 were collected. According to the classification and level of BCS and clinical symptoms of patients, percutaneous vena cava and hepatic vein balloon angioplasty, inferior vena cava or hepatic vein or collateral vessels stent angioplasty, vena cava and hepatic vein combined with stent angioplasty, hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach, transjugular intrahepatic portosystemic shunt (TIPS) combined with inferior vena cava (hepatic vein) stent angioplasty and TIPS were conducted. Observation indicators included (1) results of surgical treatment, (2) surgery-related complications, (3) changes of pre- and post-operative vascular pressures. Measurement data with normal distribution were presented as ±s, and repeated measures data were analyzed by the repeated measures ANOVA. Results (1) Results of surgical treatment: 1 241 of 1 246 patients with BCS received successful interventional treatment, including 163 undergoing percutaneous inferior vena cava or hepatic vein balloon angioplasty, 61 undergoing double balloon angioplasty, 611 undergoing inferior vena cava or hepatic vein or collateral vessels stent angioplasty, 85 undergoing inferior vena cava and hepatic vein combined with stent angioplasty, 13 undergoing hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach, 58 undergoing TIPS combined with inferior vena cava stent angioplasty, 7 undergoing TIPS combined with hepatic vein stent angioplasty and 243 undergoing TIPS. Five patients didn't receive successful interventional treatment, including that occlusion in the length of inferior vena cava cannot be opened in 2 patients, partial occlusion of hepatic vein cannot be opened in 2 patients, and unsuccessful TIPS due to total occlusion of hepatic vein was in 1 patient. (2) Surgery-related complications: 1 patient died of liver puncture pleural bleeding and respiratory circulatory failure. Four patients had severe complications, including 1 with abdominal bleeding, 1 with pericardial effusion due to partial stents of inferior vena cava migrated to right atrium, 1 with acute occlusion of hepatic vein stent and 1 with pericardial effusion due to punch through the right atrium and pericardium, and they were cured by symptomatic treatment. (3) Changes of pre- and post-operative vascular pressures: pressures of portal vein, inferior vena cava and hepatic vein from pre-operation to post-operation were (3.8±0.7)kPa to (2.3±0.6) kPa, (2.9±0.4)kPa to (1.7±0.5)kPa, (2.6±0.4)kPa to (1.4±0.3)kPa, respectively, showing statistically significant differences between the pre-operation and post-operation (F= 3.26, 2.58, 2.79, P<0.05). Conclusion According to the classification, degree and clinical symptoms of BCS, it is safe and effective to choose different interventional treatment of BCS, with a satisfactory efficacy. Key words: Budd-Chiari syndrome; Interventionnal Radiology

Good Clinical Outcomes in Budd-Chiari Syndrome with Hepatic Vein Occlusion.

Budd-Chiari syndrome (BCS) with hepatic vein (HV) occlusion is manifested by severe liver damage in acute cases and esophageal variceal bleeding or refractory ascites in chronic cases, which is difficult to differentiate from cirrhotic portal hypertension. To evaluate the clinical efficacy and safety of HV angioplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of BCS with HV occlusion. Between May 1995 and December 2014, 60 patients with HV occlusive BCS underwent HV angioplasty or TIPS. BCS was subacute or chronic in 55 patients and acute in 5 patients. HV angioplasty was performed in 18 patients with HV occlusion, combined HV and IVC angioplasty in 9 patients with HV and IVC occlusion, TIPS in 12 patients with HV occlusion, and modified TIPS in 21 patients with extensive HV occlusion. The interventional procedure was successfully performed in all 60 patients. The portal pressure decreased from 41.23±10.46cmH2O preoperatively to 26.68±6.46cmH2O postoperatively, while the portal flow velocity increased from 14.31±10.43 to 52.16±13.68cm/s in patients undergoing TIPS or modified TIPS. During hospitalization, two patients died from hepatic failure, and acute shunt occlusion occurred in two other patients during subsequent treatment with repeated intervention. During 82.25±46.16months of follow-up, three patients underwent re-intervention with a stenotic shunt, and other three with repeated dilation of the stenotic HV. HV angioplasty and TIPS yield excellent long-term outcomes in patients with HV occlusive BCS.

Hypersplenism in Patients with Extrahepatic Portal Venous Obstruction (EHO): Its Correlation with Splenomegaly and Severity of Portal Hypertension

HVOTO and HCC was assessed. Results: Sixteen HVOTO-HCC patients (10 females, 6 males) of mean age of 38 + 11.5 years were studied. Pain was their commonest presenting symptom 10/ 16 (62.5%). No signs of hepatic decompensation were noted. AFP was markedly elevated (mean 43447.1 ng/ ml). On MPCT, all had cirrhosis, mean mass size was 6.2 + 4.7 cm, 14/16 (87.5%) were well-defined, had necrosis 10/16 (62.5%), capsulated 11/16 (68.7%) and predominantly exophytic 10/16 (62.5%). Combined inferior vena cava (IVC) + hepatic vein(HV) block was commonest 12/16 (75%) followed by isolated IVC or HV block in 2 (12.5%) patients each. For HVOTO, 12 patients received therapy [Transjugular intrahepatic portosystemic shunt 1, IVC angioplasty 5, IVC angioplasty + stenting1, HV angioplasty + stenting 3, IVC + HV angioplasty 2]. Complete (CR)/partial response (PR) was achieved in 10 patients, one procedure failed and in one response could not be assessed. For coexistent HCC, 12 patients were treated [Trans-arterial chemoembolization (TACE) 5, TACE plus acetic acid ablation 3, TACE followed by transarterial chemotherapy (TAC) 1, TAC 2 and oral chemotherapy 1]. Tumor response could be assessed in 9 patients (CR 5, PR 4). Conclusion: HVOTO-HCC has unique clinical and imaging features. Treatment requires great skill and expertise as it is mandatory to treat both HVOTO and HCC for an effective outcome.

Infantile Budd-Chiari and response to balloon dilatation

Budd-Chiari Syndrome (BCS) is a rare hepatic disease caused by occlusion of the hepatic venous outflow. Percutaneous hepatic vein angioplasty (PHVA) may also achieve symptomatic relief in patients with BCS caused by short length hepatic vein stenosis or occlusion. However, effectiveness of PHVA in infants with BCS is rarely reported. We report two children with infantile Budd-Chiari who responded to balloon dilatation.

Necessity and indications of invasive treatment for Budd-Chiari syndrome

The development of collaterals in Budd-Chiari syndrome has been described and these collaterals play an important role in the presentation of this disease. These collaterals are diagnostic and their use in management strategy has never been evaluated. This study aimed to investigate the indications, feasibility and necessity of invasive treatment for patients with Budd-Chiari syndrome and to determine whether such a strategy is necessary for optimal management. Twenty-nine patients who had been treated at our unit were enrolled in this study. Based on physical and biochemical examination, and hemodynamic compensation by collaterals, 18 patients underwent radiological intervention (group A), while the other 11 had no invasive treatment (group B). The related hemodynamic parameters were acquired when percutaneous angiography was performed. In group A, all patients underwent successfully inferior vena cava (IVC) balloon angioplasty with or without stenting. Four patients also underwent hepatic vein angioplasty. In these patients, the mean IVC pressure before and after treatment was statistically different (29.3+/-9.2 vs 15.1+/-4.6 mmHg, P<0.01). The mean IVC pressure was much lower in group B than in group A (12.9+/-2.4 vs 29.3+/-9.2 mmHg, P<0.01), but there was no difference from that of the patients after radiological treatment (12.9+/-2.4 vs 15.1+/-4.6 mmHg, P>0.05). Median follow-up was 32.3 months (mean 21.3 months; range 3-61 months). In the course of follow-up, the patients in group A survived with good systemic status except for re-stenosis in one patient who underwent re-canalization of the IVC. In group B, 10 patients had good systemic status except one patient who had a meso-caval shunt because of deterioration. The rationale of "early diagnosis and early treatment" is not suitable for all patients with Budd-Chiari syndrome. Satisfactory survival can be achieved in some patients without invasive treatment, who are completely compensated by rich collaterals. Nonetheless, a positive treatment procedure should be performed if the patient's situation worsens in the course of regular follow-up.

Obliterative hepatocavopathy - ultrasound and cavography findings

Obliterative hepatocavopathy - ultrasound and cavography findingsBackgound. Obliterative hepatocavopathy is a relatively new term for the definition of primary inferior vena cava thrombosis and membranous obstruction of inferior vena cava that were included in Budd-Chiari syndrome.Case report. In this report, cavography and ultrasound findings of a case with a complete occlusion of inferior vena cava in a 36 year-old female patient who has been followed up with the diagnosis of hepatitis B related cirrhosis for 5 years were presented.Conclusions. Although this disease classically treated by surgery (e.g. portal or mesenteric-systemic shunting, liver transplantation), also interventional radiology procedures e.g. transjugular intrahepatic portosystemic shunting, percutaneous hepatic vein angioplasty and/or stent placement), now play an important role in the management4.

Managing Budd-Chiari syndrome: a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting

BACKGROUNDThe role of percutaneous hepatic vein angioplasty in the management of Budd-Chiari syndrome has not been well defined. Over a 10 year period at our unit, we have often used...

Recovery of graft circulation following percutaneous transluminal angioplasty for stenotic venous complications in pediatric liver transplantation: assessment with Doppler ultrasound

Abstract Percutaneous transluminal angioplasty was performed for venous stenosis after living related liver transplantation in three children. Two of them had hepatic vein stenosis and one had stenosis of both the hepatic and portal veins. Progressive development of ascites and deterioration of liver function were found in all cases. Serial Doppler ultrasound studies showed that the flow velocity in the hepatic vein gradually decreased with a flattened velocity waveform, followed by a decrease in portal blood flow. After a successful hepatic vein angioplasty, the velocity in the hepatic and portal veins increased and the Doppler waveform in the hepatic vein became pulsatile in two cases. In the remaining case, a remarkable recovery of both graft perfusion and clinical findings was achieved via combined hepatic vein and portal vein angioplasty. We conclude that balloon angioplasty is an effective alternative to surgery for post-transplant vascular stenosis and that Doppler ultrasound is useful in monitoring graft circulation.

Therapeutic hepatic vein angioplasty for Budd-Chiari syndrome

The authors report a case of Budd-Chiari syndrome treated by percutaneous transluminal angioplasty (PTA). In this case, the occlusion of three major hepatic veins with a big collateral to the inferior vena cava via the right inferior hepatic vein (RIHV) and stenosis of the ostium of RIHV were seen. We performed successful PTA of this stenosis.