Ultrasonically guided percutaneous transhepatic hepatic vein stent placement for Budd-Chiari syndrome

PURPOSE: To evaluate the utility of ultrasonically guided hepatic vein sten t placement in the treatment of Budd-Chiari syndrome (BCS) in patients with short hepatic vein obstruction. MATERIALS AND METHODS: Twenty-five patients with BCS, each with three obstr ucted hepatic veins diagnosed with ultrasound (US), color Doppler, probing with guide wire, and echo contrast, underwent hepatic vein stent placement under US guidance. Nine patients had hepatic vein obstruction alone, and 16 had hepatic vein obstruction along with primary inferior vena cava (IVC) o bstruction, In each patient, only one of the hepatic veins was selected for recanalization and stent placement, In patients with primary NC lesions, a stent was placed in the NC first, Clinical and US examinations were perfor med at 3-6-month intervals on every patient during follow-up, RESULTS: Hepatic vein stents were successfully placed in 23 of the 25 patie nts, a success rate of 92%, The mean +/- SD hepatic vein pressure decreased from 25.57 mm Hg +/- 9.46 to 9.67 mm Hg +/- 2.31 (P < .01), and the flow d irection in the hepatic vein became centripetal and its spectral analysis s howed a normal phasic flow, Twenty-two patients experienced a significant i mprovement in hepatic outflow, as evidenced by disappearance of ascites, re mission of hepatosplenomegaly, improvement in liver function, and alleviati on of esophageal varices, Severe intraperitoneal hemorrhage occurred in one patient, No other serious procedure-related complications were observed. D uring follow-up of 1-43 months (mean, 23 months), stent reocclusion occurre d in one patient. The other stents remained patent, and clinical features o f BCS did not recur. CONCLUSION: Percutaneous transhepatic hepatic vein stent placement is a rea sonable treatment for BCS in patients with hepatic vein obstruction, and th e procedures can be performed safely and accurately with US.