Budd-Chiari syndrome caused by obstruction of the hepatic inferior vena cava: immediate and 2-year treatment results of transluminal angioplasty and metallic stent placement.
OBJECTIVE
To assess the usefulness of percutaneous transluminal angioplasty (PTA) and expandable metallic stent (EMS) placement for treatment of Budd-Chiari syndrome (BCS).


METHODS
Thirty-two patients with BCS were treated by PTA alone or by PTA and EMS placement. Among the 32 patients, a membranous obstruction was found in 24 and a segmental stenosis or occlusion in 8 patients. The follow-up period for PTA was 38-68 months (mean 52.2 months); for EMS it was 20-36 months (mean 24.3 months).


RESULTS
Twenty-one patients underwent PTA as the primary treatment. Of these, one patient died of disseminated intravascular coagulation shortly after the procedure; 20 had good to excellent initial angiographic and clinical results. Of the 20, restenosis or reocclusion developed in 10 patients (48%), all before 27 months; 8 patients (38%) became symptomatic, and 2 remained symptom-free for a total recurrent obstruction rate of 50%. The EMS group of 17 patients included 11 patients who underwent primary stenting and 6 patients with secondary stenting after recurrence following primary PTA; restenosis was demonstrated in only 2 patients (12%).


CONCLUSIONS
We conclude that PTA alone produces excellent short-term results and about 50% sustained patency after 2 years in patients with BCS; therefore it should remain the procedure of first choice. Stents should be reserved for primary or secondary PTA failures.
Xu
K
K
Department of Radiology, First Teaching Hospital of China Medical University, Shenyang, China.
He
F X
FX
Zhang
H G
HG
Zhang
X T
XT
Han
M J
MJ
Wang
C R
CR
Kaneko
M
M
Takahashi
M
M
Okawada
T
T
D000328:Adult; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012008:Recurrence; D015607:Stents; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging