Primary Budd-Chiari syndrome: Outcome of endovascular management for suprahepatic venous obstruction Byung-Boong Lee, MD, PhD, Leonel Villavicencio,

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Presentation transcript:

Primary Budd-Chiari syndrome: Outcome of endovascular management for suprahepatic venous obstruction Byung-Boong Lee, MD, PhD, Leonel Villavicencio, MD, Young Wook Kim, MD, Young Soo Do, MD, Kwang Chul Koh, MD, Hyo Keun Lim, MD, Jae Hoon Lim, MD, Keung Whan Ahn, MD Journal of Vascular Surgery Volume 43, Issue 1, Pages 101-108 (January 2006) DOI: 10.1016/j.jvs.2005.09.003 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Duplex ultrasonographic findings of various intrahepatic conditions due to primary Budd-Chiari syndrome (BCS). A, Collateral vein is displayed as typical “ring” shape connection (white arrows) between right (RMV) and middle hepatic veins (MHV), reflecting hepatic venous outflow obstruction. B, Left hepatic vein demonstrates a lack of blood flow following the thrombosis. C, Focal stenosis of suprahepatic inferior vena cava (IVC) is shown as the cause of hepatic venous outflow obstruction. It is most probably due to the membranous obstruction of the IVC, the most common cause of primary BCS. D, Segmental stenosis of IVC (2.87 cm) is shown with evidence of portal hypertension. Journal of Vascular Surgery 2006 43, 101-108DOI: (10.1016/j.jvs.2005.09.003) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Endovascular management of focal stenotic lesion with balloon angioplasty alone. A, Duplex scan demonstrates membranes (arrows) as the cause of obstruction; it depicts focal stenosis of the inferior vena cava (IVC) as the cause of Budd-Chiari syndrome. B, Angiographic finding displays a tight stenosis of suprahepatic IVC. C, Shows the excellent hemodynamic response to angioplasty alone to relieve portal hypertension subsequently; a residual stenosis of 31% remains despite complete reduction of the pressure gradient. Journal of Vascular Surgery 2006 43, 101-108DOI: (10.1016/j.jvs.2005.09.003) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Endovascular management of hepatic vein outlet obstruction with angioplasty plus stent procedure. A, Angiographic finding of balloon angioplasty from the hepatic vein outlet to the inferior vena cava (IVC), which is the initial procedure to place a transjugular intrahepatic portosystemic shunt (TIPS) to relieve portal hypertension. B, Angiography depicts successful stenting procedure over the balloon-dilated and newly established portosystemic shunt. Journal of Vascular Surgery 2006 43, 101-108DOI: (10.1016/j.jvs.2005.09.003) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Surgical management of inferior vena cava (IVC) occlusion with mesoatrial bypass to relieve portal hypertension. A, Clinical appearance depicts extensive collateral veins (arrows) to compensate IVC occlusion along the distended abdominal wall with ascites. B, Operative finding shows extensive collateral veins (arrows) through the properitoneal layer of abdominal wall. C, End-to-side anastomosis of polytetrafluoroethylene ring graft (arrow) to the superior mesenteric vein is displayed as a part of mesoatrial bypass surgery to decompress portal hypertension. D, Mesoatrial bypass graft (arrows) is being led into the mediastinal space anteriorly to the liver for the proximal anastomosis to the right atrium. E, Duplex ultrasonographic evaluation depicts excellent blood flow through the superior mesenteric vein after successful decompression of portal hypertension with bypass. F, Excellent antegrade blood flow through the graft demonstrates well-functioning graft (G) diverting the portal blood flow to the right atrium. H, Fully restored blood flow within the right hepatic vein displays successful decompression of portal hypertension by the bypass. Journal of Vascular Surgery 2006 43, 101-108DOI: (10.1016/j.jvs.2005.09.003) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions