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Long‐term outcomes following percutaneous hepatic vein recanalization for Budd–Chiari syndrome
Author(s) -
Tripathi Dhiraj,
Sunderraj Lawrence,
Vemala Vishwaraj,
Mehrzad Homoyon,
Zia Zergham,
Mangat Kamarjit,
West Richard,
Chen Frederick,
Elias Elwyn,
Olliff Simon P
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13180
Subject(s) - medicine , budd–chiari syndrome , percutaneous , inferior vena cava , hepatic encephalopathy , surgery , stent , stenosis , retrospective cohort study , vein , ascites , radiology , cirrhosis
Background & Aims A proportion of patients with Budd–Chiari Syndrome ( BCS ) associated with stenosis or short occlusion of the hepatic vein ( HV ) or upper inferior vena cava ( IVC ) can be treated with recanalization by percutaneous venoplasty ± HV stent insertion. We studied the long‐term outcomes of this approach. Methods Single‐centre retrospective analysis of patients referred for radiological assessment ± intervention over a 27‐year period. Of 155 BCS patients, 63 patients who underwent venoplasty were studied and compared to a previously reported series treated by TIPSS ( n = 59). Results Patients treated with HV interventions (32 venoplasty alone, 31 endovascular stents): mean age, 34.9 ± 10.9; M:F ratio 27:36; median follow‐up, 113.0 months; 62% of patients had ≥1 haematological risk factor. Technical success was 100%, with symptom resolution in 73%. Cumulative secondary patency at 1, 5, 10 years was 92%, 79%, 79% and 69%, 69%, 64% in the stenting and venoplasty groups respectively. Where long‐term patency was not achieved, 10 patients required TIPSS , and 8 underwent surgery. Actuarial survival at 1, 5, 10 years was 97%, 89% and 85%. When compared to TIPSS , HV interventions resulted in similar patency and survival rates but significantly lower procedural complications (9.5% vs 27.1%) and hepatic encephalopathy (0% vs 18%). Patient age predicted survival following multivariate analysis. Conclusions Our data support the stepwise approach to management of BCS , with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.