Expandable venous stents for treatment of the Budd-Chiari syndrome

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 100; no. 5 Pt 1; p. 1435
• Main Authors: Lopez, Jr, R R, Benner, K G, Hall, L, Rösch, J, Pinson, C W
• Format: Journal Article
• Language: English
• Published: United States 01.05.1991
• Subjects: Adult; Angioplasty, Balloon; Budd-Chiari Syndrome - therapy; Hepatic Veins - diagnostic imaging; Humans; Male; Radiography; Stents; Vena Cava, Inferior - diagnostic imaging
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1016/0016-5085(91)70035-V

The goals of treatment of the Budd-Chiari syndrome are relief of portal hypertension, relief of inferior vena cava syndrome, if present, and preservation of hepatic function. This study presents a patient with clinical resolution of the Budd-Chiari syndrome after placement of expandable metallic stents in the inferior vena cava and hepatic veins. A 26-year-old man with severe ascites and lower extremity edema but with relatively preserved hepatic function had a small gradient across a suprahepatic caval web, large gradients across an intrahepatic caval stenosis and the left hepatic vein, and an occluded right hepatic vein. Under angiographic control, web and caval stenosis were balloon-dilated, and modified Gianturco expandable metallic stents were placed in the intrahepatic vena cava. The left hepatic vein was dilated twice and a stent was placed. All gradients were completely eliminated. There were no complications and after 1 year, the stents have fully expanded without migration, edema and ascites have resolved, hepatic function has normalized, and the patient has returned to work. This new technique provides a simple, safe, effective, relatively inexpensive, and potentially long-lasting treatment for selected patients with the Budd-Chiari syndrome.