MANAGEMENT OF IDIOPATHIC BUDD-CHIARI SYNDROME WITH PRIMARY STENT PLACEMENT - EARLY RESULTS

PURPOSE: To evaluate the utility of primary stent placement in the man agement of Budd-Chiari syndrome (BCS) secondary to idiopathic inferior vena caval (IVC) obstruction. PATIENTS AND METHODS: The case records of nine patients (four women, five men), ranging in age from 22 to 58 years (median, 26 years), with idiopathic IVC obstruction were reviewe d. Hepatosplenomegaly, esophageal varices, and prominent collateral ve ins were found in all patients, while four also had ascites. Hepatic f unctional reserve was graded as Child class A in three patients and cl ass B in the remaining six. All had at least one patent hepatic vein o pening into the IVC below the site of occlusion. Percutaneous angiopla sty of the IVC was performed, followed by the placement of double-skir t Gianturco-Rosch or hybrid Gianturco stents. Clinical follow-up was s upplemented with duplex ultrasound (n = 8), endoscopy (n = 4), and cav ography (n = 2). RESULTS: Caval lesions were segmental. Revascularizat ion was technically successful in all patients. The median pressure gr adient across the lesion dropped from 38 mm Hg (range, 27-61 mm Hg) to 15 mm Hg (range, 10-20 mm Hg) (P = .008). Residual stenosis after ste nt placement ranged from 9% to 40% (median, 20%). One patient died of presumed pulmonary embolism; another patient experienced an episode of epistaxis. The procedure was followed by regression of signs and symp toms in the eight survivors. During the follow-up period (range, 3-31 months; median, 7 months) the IVC remained patent in all patients, and clinical features of BCS did not recur. CONCLUSION: Primary stent pla cement could serve as the first line of treatment in patients with idi opathic BCS when the underlying lesion is not amenable to angioplasty.