Reestablishment of second hepatic hilum: a new technique for the treatment of Budd-Chiari syndrome.
OBJECTIVE
To assess a new intervention for reestablishing the second hepatic hilum by means of puncturing and stenting the liver tissue between the intrahepatic vena cava and a hepatic vein for the treatment of Budd-Chiari syndrome (BCS).


METHODS
Two patients with BCS, in which no second hepatic hilum structure was found in transhepatic venography, underwent an interventional procedure of canalizing and stenting the parenchyma tract between the intrahepatic vena cava and a hepatic vein. The procedures were performed in the percutaneous transhepatic and right jugular vein, respectively. A metallic stent with a 10 mm diameter was implanted to maintain tract patency.


RESULTS
The free hepatic vein pressure (FHVP) of both patients decreased from 37 mm Hg to 5 mm Hg and from 28 mm Hg to 4 mm Hg, respectively, after the procedure. The complication of hemorrhage due to puncture was observed in one patient. Both patients maintained hepatic improvements in 3-year follow-up. Both clinical conditions and laboratory values were significantly improved after the procedure. Furthermore, the stented canals (the reestablished second hepatic hilum) maintained patent with normal FHVP, which was confirmed by control venography.


CONCLUSIONS
The new technique provides a simple, safe, effective, and relatively inexpensive treatment of Budd-Chiari syndrome. Long-lasting effectiveness is expected.
Yang
Jianyong
J
Department of Radiology, First Affiliated Hospital of Sun Yat-Sen University of Medical Sciences, Guangzhou 510080, China. Jonson__y@163.net
Zhang
Ling
L
Yu
Shenping
S
Chen
Wei
W
Huang
Wenquan
W
Feng
Gansheng
G
Liang
Huimin
H
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000628:therapy*; D006503:Hepatic Veins; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014682:Vena Cava, Inferior