Hepatic venoplasty in Budd-Chiari syndrome
Abdominal distension, hepatomegaly and ascites. Budd-Chiari syndrome on CT
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.
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
13 public playlist include this case
- Exam cases (part 3) (part 1) by Noura Alraeesi
- BH abdomen by Dr Tony Chen
- Vascular & Intervention by Matt Page
- hepatobiliary by Susantha indika Mahindawansha
- Gefäße by Dr. David Loewenthal
- 3_116 Liver: Vascular Disorders of the Liver and Splanchnic Circulation by RAB Three
- GIT frcr by Dr Feras Salhi
- nezar hepatobiliary by nezar shlaka
- Exam cases (part 6) (part 1) by Noura Alraeesi
- Vasc/Int 1 by Sean
- Certificate: 3_116 Liver: Vascular Disorders of the Liver and Splanchnic Circulation by RAB Three
- BUDD CHIARI by BRUNA LOPES NAVES
- Angio by abdallah abu younes