RADIOLOGICAL INTERVENTION IN BUDD-CHIARI SYNDROME - TECHNIQUES AND OUTCOME IN 18 PATIENTS

We reviewed our experience of the therapeutic role of radiology in Bud d-Chiari syndrome, Patients with stenosis and/or occlusion of the main hepatic veins and/or inferior vena cava (IVC) are suitable for radiol ogical intervention (35% in our series), Eighteen patients (mean age 3 7.4 years) have undergone radiological intervention over the past 8 ye ars, The site of obstruction was the hepatic veins in 12/18 patients w hile 6/18 patients had both hepatic vein and IVC obstruction, which in two was due to tumour thrombus, One patient had repeated dilatations of a mesocaval shunt; 49 angiographic venous dilatations were performe d (18 during initial intervention, 31 on review) including 10 recanali zations of occlusions, A combined transhepatic-transjugular approach w as used for 10/49 procedures, Thrombolysis was performed in 5/18 and s tent insertion in 6/18 patients, Three serious complications occurred (IVC stent migration, hepatic artery pseudoaneurysm, myocardial punctu re), Follow-up, after initial intervention, has continued for a mean o f 24.2 months (range 4 days-92 months), Symptoms related to hepatic ve nous outflow obstruction were fully relieved in 10/18 (56%) patients a nd partially relieved in 4/18 (22%) patients, Close monitoring (and re -intervention) during the early post-intervention period is needed bec ause 28% of initial venous dilatations failed to provide adequate veno us return in the first instance, Once the patient is stabilized regula r review is mandatory as HV restenosis is common after 10 months or mo re follow-up, The efficacy and safety of radiological intervention mak e it the preferred first line of treatment in selected patients with B udd-Chiari syndrome.