Clinical study on percutaneous transhepatic angioplasty of hepatic veins in the treatment of Budd-Chiari syndrome with occlusion of hepatic veins

Objective: To investigate and evaluate the feasibility and middle, long-term efficacies of percutaneous transhepatic recanalization and angioplasty of hepatic veins (PTRAHV)in the treatment of Budd- Chiari syndrome(BCS)with occlusion of hepatic veins. Methods: From September 1996 to October 2006, 101 Budd-Chiari syndrome patients with occlusion of hepatic veins or accompanied by occlusion of inferior vena cava were recruited for the clinical study,including 65 males and 46 females (average age 42.47 years). Free hepatic vein pressure (FHVP)were measured through catheterization pre and post-angioplasty. Periprocedural complications, portal venous indexes including vessel diameter, mean flow rate and the direction, and venous patency ratio were evaluated and compared by Color Doppler during follow-up. Results: The successful ratio was 91% (92/101). During perioperative procedure, 3 patients with acute hepatic vein thrombosis, 2 with liver puncture tract bleeding, 1 with subcapsular hematoma and 1 ease with pulmonary embolism occurred but with no mortality after systemic conservative treatment. Follow-up of 6 months after PRTAHV were collected in 74 cases with portal venous indexes improvement over that of pre-procedure (P<0.05), the primary patency ratios of involved hepatic veins was 83.78%(62/74), 78.38%(58/74)and 76.47%(39/51)at 6 months, 1 and 2 years after operation respectively, and the assisted patency ratios was 94.59% (70/74), 91.89% (68/74)and 84.31% (43/51), respectively. Conclusions: PTRAHV is safe and effective option for treatment of Budd-Chiari syndrome with membraneous and segmental hepatic lesions. The middle and long-term efficacies are promising. (authors)