Hepatic venoplasty in Budd-Chiari syndrome

Case contributed by Paresh K Desai

Presentation

Abdominal distension, hepatomegaly and ascites. Budd-Chiari syndrome on CT

Patient Data

Age: 25 years
Gender: Female

Hepatic venography & venoplasty

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The inferior 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 balloon angioplasty was done. Serial balloon angioplasties were done in the right hepatic vein 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 ascites and a patent right hepatic vein.

Case Discussion

Interventional radiological management offers good hope for patients with Budd Chiari syndrome.

Conventional treatment would include long term anticoagulation only.

Now hepatic venoplasty or Transjugular intrahepatic portosystemic shunting has changed the scenario.

These procedures can be successful in maintaining long term patency and prevent/halt the progression of cirrhosis in Budd-Chiari syndrome patients.

Acknowledgements to Dr Kapil Naik, My colleague in IR

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