Management of the Budd-Chiari syndrome by balloon cavoplasty.
BACKGROUND
Obstruction of the suprahepatic inferior vena cava (IVC) by a membrane or stricture is the commonest cause of Budd-Chiari syndrome in the eastern hemisphere. We present our experience with the outcome of balloon cavoplasty in such cases.


METHODS
We followed up 40 consecutive cases of Budd-Chiari syndrome over seven years. Doppler study of hepatic venous outflow tract (in all cases), liver biopsy (30 cases) and necropsy (two cases) were performed. Balloon cavoplasty was done in selected cases.


RESULTS
Of 40 patients with BCS (mean age 35.2 [SD 8.7] years; 26 men) 5, 5 and 30 had fulminant, acute and chronic presentation, respectively. Inferior vena cavography was performed in 32 cases, and showed membranous obstruction of the IVC in 12, segmental occlusion of the IVC in 11 cases, and block in both the IVC and the main hepatic veins in the rest. Successful balloon cavoplasty was done in 18 cases with obstruction of the IVC (membrane or stricture); 15 of them are well over a mean follow up of 56 (14.6) months. Three patients developed restenosis; two of them, treated with redilatation, are doing well, and one died of septicemia and hepatic failure following a surgical bypass. Pressure gradient between the IVC and right atrium decreased significantly after cavoplasty (15.4 [2.8] vs 6.6 [2.0] mmHg; p< 0.001).


CONCLUSIONS
Balloon cavoplasty gave encouraging results in the management of Budd-Chiari syndrome due to membranous obstruction or stricture of the IVC.
De
B K
BK
Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata. binaykde@apexmail.com
Biswas
P K
PK
Sen
S
S
Das
D
D
De
K K
KK
Das
U
U
Mandal
S K
SK
Majumdar
D
D
D000293:Adolescent; D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon; D001794:Blood Pressure / Q000502:physiology; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*