Advertisement

Indian Journal of Gastroenterology

, Volume 36, Issue 3, pp 209–216 | Cite as

Budd-Chiari syndrome: outcomes of endovascular intervention—A single-center experience

  • Nitin JagtapEmail author
  • Mithun Sharma
  • Jagdeesh Singh
  • Manu Tandan
  • P N Rao
  • Rajesh Gupta
  • Sundeep Lakhtakia
  • Mohan Ramchandani
  • Harshal Shah
  • T Mahesh Kumar
  • Santosh Darishetty
  • G V Rao
  • D N Reddy
Original Article

Abstract

Aim

Outcomes of endovascular intervention in Budd-Chiari syndrome (BCS) have been reported with varied results. Clinical outcomes of endovascular interventions in BCS and role of various prognostic scores were critically evaluated in this study.

Methods

This study retrospectively analyzed consecutive patients of BCS who underwent endovascular intervention between January 2007 and May 2016 at our center. Technical, clinical successes and complications were documented. The role of the prognostic scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), Rotterdam index, and original Clichy score in predicting mortality, clinical success, and need for re-interventions were also assessed.

Results

A total of 88 patients were analyzed. The median follow up was 12 months (range 1–96 months). Thirteen (14.8%) patients had combined inferior vena cava (IVC) and hepatic vein (HV) obstruction; HV obstruction in 33 (37.5%) and inferior vena cava IVC obstruction in 42 (47.7%) patients. The following interventions were done: IVC angioplasty alone (n = 11), IVC angioplasty with stenting (n = 36), HV angioplasty with stenting (n = 26), combined HV and IVC stent (n = 2), and direct intrahepatic porto-systemic shunt (DIPS) (n = 13). Overall technical success was 87/88 (98.86%), and clinical success was 76/88 (86.36%). Immediate complications were noted in 8 patients (10%). The 1-, 2-, 3-, and 4-year stent patency rates were 90.91%, 81.08%, 74.59%, and 70.45%, respectively. Re-interventions were required in 15 (17%). Overall mortality was 6 (6.8%). Apart from MELD >14, none of the other prognostic score could predict mortality, clinical success, and need for re-interventions.

Conclusion

Endovascular interventions play an important role in the management of BCS, in properly selected patients, even if prognostic score is unfavorable.

Keywords

Budd-Chiari syndrome DIPS Endovascular interventions Prognostic scores 

Notes

Compliance with ethical standards

Conflict of interest

NJ, MS, JS, MT, PNR, RG, SL, MR, HS, TMK, SD, GVR, and DNR declare that they have no conflict of interest.

Human and animal rights

All procedures performed in patients were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Supplementary material

12664_2017_760_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)

References

  1. 1.
    European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016;64:179–202.CrossRefGoogle Scholar
  2. 2.
    Bolondi L, Gaiani S, Li Bassi S, et al. Diagnosis of Budd-Chiari syndrome by pulsed Doppler ultrasound. Gastroenterology. 1991;100:1324–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Valla DC. The diagnosis and management of the Budd-Chiari syndrome: consensus and controversies. Hepatology. 2003;38:793–803.CrossRefPubMedGoogle Scholar
  4. 4.
    Gupta S, Barter S, Phillips GW, Gibson RN, Hodgson HJ. Comparison of ultrasonography, computed tomography and 99mTc liver scan in diagnosis of Budd-Chiari syndrome. Gut. 1987;28:242–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Senzolo M, Cholongitas EC, Patch D, Burroughs AK. Update on the classification, assessment of prognosis and therapy of Budd-Chiari syndrome. Nat Clin Pract Gastroenterol Hepatol. 2005;2:182–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Janssen HLA, Garcia-Pagan JC, Elias E, et al. Budd-Chiari syndrome: a review by an expert panel. J Hepatol. 2003;38:364–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Mahmoud AE, Helmy AS, Billingham L, Elias E. Poor prognosis and limited therapeutic options in patients with Budd-Chiari syndrome and portal venous system thrombosis. Eur J Gastroenterol Hepatol. 1997;9:485–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Okuda H, Yamagata H, Obata H, et al. Epidemiological and clinical features of Budd-Chiari syndrome in Japan. J Hepatol. 1995;22:1–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Okuda K. Inferior vena cava thrombosis at its hepatic portion (obliterative hepatocavopathy). Semin Liver Dis. 2002;22:15–26.CrossRefPubMedGoogle Scholar
  10. 10.
    Datta DV, Saha S, Singh SA, Gupta BB, Aikat BK, Chhuttani PN. Clinical spectrum of Budd-Chiari syndrome in Chandigrah with particular reference to obstruction of intrahepatic portion of inferior vena cava. Indian J Med Res. 1972;60:385–402.PubMedGoogle Scholar
  11. 11.
    Taneja A, Mitra SK, Moghe PD, Rao PN, Samanta N, Kumar L. Budd-Chiari syndrome in childhood secondary to inferior vena caval obstruction. Pediatrics. 1979;63:808–12.PubMedGoogle Scholar
  12. 12.
    Aikat BK, Bhusnurmath SR, Chhuttani PN, Datta DV. Hepatic vein obstruction—a retrospective analysis of 72 autopsies and biopsies. Indian J Med Res. 1978;67:128–44.PubMedGoogle Scholar
  13. 13.
    Datta DV, Vashishta S, Samanta AK, Chhuttani PN. Diagnostic value of combined transhepatic venography and inferior vena cavography in chronic Budd-Chiari syndrome. Am J Dig Dis. 1978;23:1031–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Dilawari JB, Bambery P, Chawla Y, et al. Hepatic outflow obstruction (Budd-Chiari syndrome). Experience with 177 patients and a review of the literature. Medicine (Baltimore). 1994;73:21–36.CrossRefGoogle Scholar
  15. 15.
    Singh V, Sinha SK, Nain CK, et al. Budd-Chiari syndrome: our experience of 71 patients. J Gastroenterol Hepatol. 2000;15:550–4.CrossRefPubMedGoogle Scholar
  16. 16.
    DeLeve LD, Valla DC, Garcia-Tsao G; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology. 2009;49:1729–64.Google Scholar
  17. 17.
    Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Darwish Murad S, Valla DC, de Groen PC, et al. Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome. Hepatology. 2004;39:500–8.Google Scholar
  20. 20.
    Garcia-Pagán JC, Heydtmann M, Raffa S, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology. 2008;135:808–15.Google Scholar
  21. 21.
    Zeitoun G, Escolano S, Hadengue A, et al. Outcome of Budd-Chiari syndrome: a multivariate analysis of factors related to survival including surgical portosystemic shunting. Hepatology. 1999;30:84–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Victor S, Jayanthi V, Madanagopalan N. Coarctation of the inferior vena cava. Trop Gastroenterol. 1987;8:127–42.PubMedGoogle Scholar
  23. 23.
    Kohli V, Pande GK, Dev V, Reddy KS, Kaul U, Nundy S. Management of hepatic venous outflow obstruction. Lancet. 1993;342:718–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Chawla Y, Kumar S, Dhiman RK, Suri S, Dilawari JB. Duplex Doppler sonography in patients with Budd-Chiari syndrome. J Gastroenterol Hepatol. 1999;14:904–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Amarapurkar DN, Punamiya SJ, Patel ND. Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment. World J Gastroenterol. 2008;14:278–85.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Eapen CE, Mammen T, Moses V, Shyamakumar NK. Changing profile of Budd-Chiari syndrome in India. Indian J Gastroenterol. 2007;26:77–81.PubMedGoogle Scholar
  27. 27.
    Tanaka M, Wanless IR. Pathology of the liver in Budd-Chiari syndrome: portal vein thrombosis and the histogenesis of veno-centric cirrhosis, veno-portal cirrhosis, and large regenerative nodules. Hepatology. 1998;27:488–96.CrossRefPubMedGoogle Scholar
  28. 28.
    Gonzalez-Flecha B, Reides C, Cutrin JC, Llesuy SF, Boveris A. Oxidative stress produced by suprahepatic occlusion and reperfusion. Hepatology. 1993;18:881–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Bilbao JI, Pueyo JC, Longo JM, et al. Interventional therapeutic techniques in Budd-Chiari syndrome. Cardiovasc Intervent Radiol. 1997;20:112–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Fisher NC, McCafferty I, Dolapci M, et al. Managing Budd-Chiari syndrome: a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting. Gut. 1999;44:568–74.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    De BK, Biswas PK, Sen S, et al. Management of the Budd-Chiari syndrome by balloon cavoplasty. Indian J Gastroenterol. 2001;20:151–4.PubMedGoogle Scholar
  32. 32.
    Puri SK, Goel M, Kumar N, Chaudhary A, Gupta S. Percutaneous transluminal balloon angioplasty in suprahepatic IVC obstruction—Budd-Chiari syndrome. Trop Gastroenterol. 1995;16:39–42.PubMedGoogle Scholar
  33. 33.
    Zhang CQ, Fu LN, Xu L, et al. Long-term effect of stent placement in 115 patients with Budd-Chiari syndrome. World J Gastroenterol. 2003;9:2587–91.Google Scholar
  34. 34.
    Baijal SS, Roy S, Phadke RV, Agrawal DK, Kumar S, Choudhuri G. Management of idiopathic Budd-Chiari syndrome with primary stent placement: early results. J Vasc Interv Radiol. 1996;7:545–53.CrossRefPubMedGoogle Scholar
  35. 35.
    Perelló A, García-Pagán JC, Gilabert R, et al. TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy. Hepatology. 2002;35:132–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Rössle M, Olschewski M, Siegerstetter V, Berger E, Kurz K, Grandt D. The Budd-Chiari syndrome: outcome after treatment with the transjugular intrahepatic portosystemic shunt. Surgery. 2004;135:394–403.CrossRefPubMedGoogle Scholar
  37. 37.
    Keshava SN, Kota GK, Mammen T, et al. Direct intrahepatic cavo-portal shunts in Budd-Chiary syndrome: role of simultaneous fluoroscopy and trans-abdominal ultrasonography. Indian J Gastroenterol. 2006;25:248–50.PubMedGoogle Scholar
  38. 38.
    Mancuso A, Fung K, Mela M, et al. TIPS for acute and chronic Budd-Chiari syndrome: a single-centre experience. J Hepatol. 2003;38:751–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Darwish Murad S, Kim WR, de Groen PC, et al. Can the model for end-stage liver disease be used to predict the prognosis in patients with Budd-Chiari syndrome? Liver Transpl. 2007;13:867–74.CrossRefPubMedGoogle Scholar
  40. 40.
    Montano-Loza AJ, Tandon P, Kneteman N, Bailey R, Bain VG. Rotterdam score predicts early mortality in Budd-Chiari syndrome, and surgical shunting prolongs transplant-free survival. Aliment Pharmacol Ther. 2009;30:1060–9.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2017

Authors and Affiliations

  • Nitin Jagtap
    • 1
    Email author
  • Mithun Sharma
    • 1
  • Jagdeesh Singh
    • 1
  • Manu Tandan
    • 1
  • P N Rao
    • 1
  • Rajesh Gupta
    • 1
  • Sundeep Lakhtakia
    • 1
  • Mohan Ramchandani
    • 1
  • Harshal Shah
    • 1
  • T Mahesh Kumar
    • 1
  • Santosh Darishetty
    • 1
  • G V Rao
    • 1
  • D N Reddy
    • 1
  1. 1.Department of Gastroenterology and HepatologyAsian Institute of GastroenterologyHyderabadIndia

Personalised recommendations