Hepatic venoplasty in Budd-Chiari syndrome
Abdominal distension, hepatomegaly and ascitis. Budd Chiari Syndrome on CT
Hepatic venography & venoplasty
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The Inferiro vena cava gram reveals indentation of the IVC by the enlarged caudate lobe.
There is no stenosis/ occlusion of the Inferior vena cava. The hepatic veins are occluded. Injection into the right hepatic vein reveals the spider web pattern with intrahepatic collateralisation.
The right hepatic vein was successfully cannulated and baloon angiopasty done. Serial baloon angioplasties were done in the RHV and a 40mmx8mm self expanding Stent was placed - Zilverex- COOK.
Although the stent is not in the ideal position; the pressure gradient fell from 25 to 12mm Hg.
On serial follow up the patient is doing well. There is complete regression of ascitis and a patent right hepatic vein.
Interventional radiological management offers good hope for the patients with Budd Chiari syndrome.
Conventional treatment would include long term anticoagulation only.
Now hepatic venoplasty or Transjugular intrahepatic portovenous shunting has changed the scenario.
These procedures can be successful in maintaining long term partency and prevent/ halt progression of Cirrhosis in BCS patients.
Acknowledgements to Dr Kapil Naik, My colleague in IR