Expandable venous stents for treatment of the Budd-Chiari syndrome.
The goals of treatment of the Budd-Chiari syndrome are relief of portal hypertension, relief of inferior vena cava syndrome, if present, and preservation of hepatic function. This study presents a patient with clinical resolution of the Budd-Chiari syndrome after placement of expandable metallic stents in the inferior vena cava and hepatic veins. A 26-year-old man with severe ascites and lower extremity edema but with relatively preserved hepatic function had a small gradient across a suprahepatic caval web, large gradients across an intrahepatic caval stenosis and the left hepatic vein, and an occluded right hepatic vein. Under angiographic control, web and caval stenosis were balloon-dilated, and modified Gianturco expandable metallic stents were placed in the intrahepatic vena cava. The left hepatic vein was dilated twice and a stent was placed. All gradients were completely eliminated. There were no complications and after 1 year, the stents have fully expanded without migration, edema and ascites have resolved, hepatic function has normalized, and the patient has returned to work. This new technique provides a simple, safe, effective, relatively inexpensive, and potentially long-lasting treatment for selected patients with the Budd-Chiari syndrome.
Lopez
R R
RR
Department of Surgery, Oregon Health Sciences University and Surgical Service, Veterans Affairs Medical Center, Portland.
Benner
K G
KG
Hall
L
L
Rösch
J
J
Pinson
C W
CW
D000328:Adult; D000800:Angioplasty, Balloon; D006502:Budd-Chiari Syndrome / Q000628:therapy*; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011859:Radiography; D015607:Stents; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging