Angioplasty for long-term treatment of patients with Budd-Chiari syndrome.

Abstract

The goal of radiologic intervention in patients with Budd-Chiari syndrome is to control portal hypertension and prevent further hepatocellular damage until collateral hepatic venous outflow channels can develop. Percutaneous balloon angioplasty was used to treat six patients with this syndrome who were followed up for an average of 43 months (range, 12-92 months). Standard interventional radiologic techniques were used to dilate the hepatic veins (two patients), inferior vena cava (three patients), and proximal anastomosis of a mesoatrial shunt (one patient). Angioplasty was the only invasive treatment in three patients, whereas the remaining three patients had previous portosystemic shunts. Clinical and hemodynamic improvement occurred after each angioplasty. Multiple dilatations were required in all patients (average, 3.2; range, 2-5) because of restenosis at the angioplasty site and ongoing hepatocyte necrosis shown by biopsy. Long-term benefit occurred in five patients despite ultimate caval occlusion...