title: Long-term outcomes following percutaneous hepatic vein recanalization for Budd-Chiari syndrome.
abstract: A proportion of patients with Budd-Chiari Syndrome (BCS) associated with stenosis or short occlusion of the hepatic vein (HV) or upper inferior vena cava (IVC) can be treated with recanalization by percutaneous venoplasty ± HV stent insertion. We studied the long-term outcomes of this approach.
  
  
  
  Single-centre retrospective analysis of patients referred for radiological assessment ± intervention over a 27-year period. Of 155 BCS patients, 63 patients who underwent venoplasty were studied and compared to a previously reported series treated by TIPSS (n = 59).
  
  
  
  Patients treated with HV interventions (32 venoplasty alone, 31 endovascular stents): mean age, 34.9 ± 10.9; M:F ratio 27:36; median follow-up, 113.0 months; 62% of patients had ≥1 haematological risk factor. Technical success was 100%, with symptom resolution in 73%. Cumulative secondary patency at 1, 5, 10 years was 92%, 79%, 79% and 69%, 69%, 64% in the stenting and venoplasty groups respectively. Where long-term patency was not achieved, 10 patients required TIPSS, and 8 underwent surgery. Actuarial survival at 1, 5, 10 years was 97%, 89% and 85%. When compared to TIPSS, HV interventions resulted in similar patency and survival rates but significantly lower procedural complications (9.5% vs 27.1%) and hepatic encephalopathy (0% vs 18%). Patient age predicted survival following multivariate analysis.
  
  
  
  Our data support the stepwise approach to management of BCS, with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Tripathi
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Sunderraj
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Vishwaraj
authors.initials: V
authors.lastname: Vemala
authors.affiliation: Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Homoyon
authors.initials: H
authors.lastname: Mehrzad
authors.affiliation: Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Zergham
authors.initials: Z
authors.lastname: Zia
authors.affiliation: Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.|Department of Radiology, National University Hospital, Singapore.
authors.forename: Kamarjit
authors.initials: K
authors.lastname: Mangat
authors.affiliation: Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: West
authors.affiliation: Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Frederick
authors.initials: F
authors.lastname: Chen
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Elias
authors.affiliation: Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Olliff
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D006113:United Kingdom; D014682:Vena Cava, Inferior / Q000601:surgery; D055815:Young Adult
keywords: ascites; liver; portal hypertension; radiology/imaging