Balloon Angioplasty for Budd-Chiari Syndrome

Source: Yang XL, et al. J Am Coll Cardiol 1996;28:1720-1724.

Budd-chiari syndrome (bcs) is an unusual, debilitating disorder due to hepatic venous outflow obstruction caused by a variety of disorders divided into primary and secondary causes. Primary BCS refers to congenital obstruction of the hepatic veins or hepatic portion of the inferior vena cava (IVC), better known as membranous obstruction of the IVC (MOVC). MOVC is the most common cause world wide (33%) and is common in the Orient and South Africa. Echocardiography in patients with the typical signs of portal hypertension and IVC obstruction shows the diagnostic dilation of the IVC and hepatic veins below a suprahepatic caval web. Color Doppler shows stagnant or reversed flow in the portal vein. MRI or venography may be required to detect thrombosis of the IVC, which is an absolute contraindication to percutaneous balloon angioplasty (PTBA) of the membrane. A series of 42 Chinese patients who underwent PTBA for MOVC using the Inoue balloon catheter showed a success rate of 91%. Over an eight-year follow-up, all successful cases improved symptomatically and objectively, and MOVC recurred in only one patient who was treated with PTBA plus a stent. The four acute failures were due to massive pulmonary embolus in one and excessive membrane thickness in the three who were treated surgically. Surgery can be successful, but the technical difficulties of venous repair in this area results in lower five-year survival (60%). Clearly, PTBA using the Inoue balloon catheter is safe and highly effective therapy for BCS due to MOVC.—mhc