Outcomes of Hepatic Venoplasty in Budd-Chiari Syndrome.

Objective: To observe medium to long-term outcomes of hepatic venoplasty in patients with Budd-Chiari syndrome (BCS).

Study design: An observational study. Place and Duration of the Study: Department of Gastroenterology and Radiology, Shaikh Zayed Hospital, Lahore, Pakistan, from February 2021 to December 2022.

Methodology: After obtaining ethical approval, adult patients presenting to the authors' Institute with BCS and candidates for venoplasty were recruited. After the procedure, they were followed up for twelve months.

Results: Twenty-five patients were recruited including 18 (72%) males and 7 (28%) females. Vascular occlusion was due to identified hypercoagulable state in 11 (44%) and idiopathic in 14 (56%). Eight (32%) patients had liver cirrhosis. Ascites was present in 24 (96%) patients prior to venoplasty. Twenty-one (84%) patients had varices. Stage of liver disease was child A in 5 (20%), B in 16 (64%), and C in 4 (16%). Vascular blockage involved all hepatic veins in nearly a quarter of patients. Vascular stenting post-venoplasty was done in 18 (72%). All patients received warfarin (target INR 2-2.5). Twelve months after venoplasty, 4 (16%) patients had undergone liver transplantation, 4 (16%) lost to follow up, and 6 (24%) had expired due to cirrhosis-related complications. In the remaining 11 (44%), hepatic veins were patent in 10 (40%) and blocked in 1 (4%). One (4%) patient had significant ascites, whereas significant-sized varices were noted in 2 (8%).

Conclusion: Venoplasty results in good long-term outcomes in patients with BCS if they have not developed advanced cirrhosis. In patients with cirrhosis, outcomes are suboptimal and liver transplantation remains the only curative option. This highlights the importance of early detection and specialist centre referral before cirrhosis develops.

Key words: Budd-Chiari Syndrome, Venoplasty, Cirrhosis.