Treatment of the budd-chiari syndrome with percutaneous transluminal angioplasty. Case report and review of the literature

A patient with the Budd-Chiari syndrome due to membranous obstruction of the right hepatic vein and long segmental obstruction of the inferior vena cava who was successfully treated with percutaneous transluminal angioplasty is described. Review of the literature revealed 14 prior cases of balloon dilatation of the hepatic venous system: 10 of the hepatic portion of the inferior vena cava, three of the right hepatic vein, and one of the left hepatic vein. Follow-up ranged from six months to 37 months. No serious complications were reported. All attempts at dilatation were successful, but reocclusion occurred in six patients, three of whom had occlusion of the hepatic vein. All but one patient with reocclusion, however, underwent repeated angioplasty, which was successful in all cases attempted. Two patients who had repeated angioplasty required no further therapy, but two patients required a total of three angioplasties and two patients required four angioplasties. Successful angioplasty was accompanied by resolution of clinical symptoms in all patients described. It is concluded that percutaneous transluminal angioplasty is a safe and effective mode of therapy in the management of the Budd-Chiari syndrome due to membranous obstruction of the hepatic portion of the inferior vena cava or the hepatic veins.