Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center
Background : Budd - Chiari syndrome (BCS) due to hepatic venous outflow obstruction is a rare cause of liver disease with dismal outcome, often amenable to catheter intervention. Materials and Methods : This retrospective single-center study analyzed the clinical profile and medium-term outcome of i...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Annals of Pediatric Cardiology |
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| Online Access: | http://www.annalspc.com/article.asp?issn=0974-2069;year=2023;volume=16;issue=3;spage=168;epage=174;aulast=Kodandarama |
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| author | Usha Mandikal Kodandarama Sastry Madhu Swandenahalli Doddaiah Priyadarshini Arunakumar Varun Marimuthu Sowmya Kasturi Budnur C Srinivas Mahimarangaiah Jayranganath Cholenahally Nanjappa Manjunath |
| author_facet | Usha Mandikal Kodandarama Sastry Madhu Swandenahalli Doddaiah Priyadarshini Arunakumar Varun Marimuthu Sowmya Kasturi Budnur C Srinivas Mahimarangaiah Jayranganath Cholenahally Nanjappa Manjunath |
| author_sort | Usha Mandikal Kodandarama Sastry |
| collection | DOAJ |
| description | Background : Budd - Chiari syndrome (BCS) due to hepatic venous outflow obstruction is a rare cause of liver disease with dismal outcome, often amenable to catheter intervention.
Materials and Methods : This retrospective single-center study analyzed the clinical profile and medium-term outcome of interventional treatment with balloon angioplasty ± stenting in all pediatric BCS over a 10-year period. Clinical, laboratory, imaging, and interventional data were retrieved. Transhepatic (TH) access was utilized in the recent 3 years.
Results : We included a total of 27 patients. Acute and subacute BCS comprised 93% of subjects. Ascites was the most common symptom. COVID-19 infection and Takayasu arteritis were two novel etiologies in our study. There was isolated hepatic vein (HV) narrowing in 11 (41%), isolated inferior vena cava obstruction in 4, and combined occlusion in 12 (44%). Intervention was successful in 22 (82%) patients. Stenting was required in 14 (64%) patients and the rest underwent balloon angioplasty. The immediate outcome was better with stenting than balloon (91% vs. 64%). Transhepatic access in 6 patients allowed HV cannulation in all and achieved patency in five patients. Two patients from the balloon group (25%) and 9 from the stent group (64%) are alive with patent veins at a median follow-up of 60 months, indicating a high attrition rate.
Conclusion : Catheter interventions restored physiological blood flow in pediatric BCS. TH route improved cannulation of occluded HV compared to other accesses. Immediate and medium-term outcomes were better after stenting with lower rates of reinterventions than balloon angioplasty. Life-long surveillance is required as mortality is high on follow-up. |
| first_indexed | 2024-03-11T15:47:07Z |
| format | Article |
| id | doaj.art-74d00e3c8eb54a87ab031b56ba715eb2 |
| institution | Directory Open Access Journal |
| issn | 0974-2069 |
| language | English |
| last_indexed | 2024-03-11T15:47:07Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Pediatric Cardiology |
| spelling | doaj.art-74d00e3c8eb54a87ab031b56ba715eb22023-10-26T05:47:19ZengWolters Kluwer Medknow PublicationsAnnals of Pediatric Cardiology0974-20692023-01-0116316817410.4103/apc.apc_160_22Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary centerUsha Mandikal Kodandarama SastryMadhu Swandenahalli DoddaiahPriyadarshini ArunakumarVarun MarimuthuSowmya KasturiBudnur C SrinivasMahimarangaiah JayranganathCholenahally Nanjappa ManjunathBackground : Budd - Chiari syndrome (BCS) due to hepatic venous outflow obstruction is a rare cause of liver disease with dismal outcome, often amenable to catheter intervention. Materials and Methods : This retrospective single-center study analyzed the clinical profile and medium-term outcome of interventional treatment with balloon angioplasty ± stenting in all pediatric BCS over a 10-year period. Clinical, laboratory, imaging, and interventional data were retrieved. Transhepatic (TH) access was utilized in the recent 3 years. Results : We included a total of 27 patients. Acute and subacute BCS comprised 93% of subjects. Ascites was the most common symptom. COVID-19 infection and Takayasu arteritis were two novel etiologies in our study. There was isolated hepatic vein (HV) narrowing in 11 (41%), isolated inferior vena cava obstruction in 4, and combined occlusion in 12 (44%). Intervention was successful in 22 (82%) patients. Stenting was required in 14 (64%) patients and the rest underwent balloon angioplasty. The immediate outcome was better with stenting than balloon (91% vs. 64%). Transhepatic access in 6 patients allowed HV cannulation in all and achieved patency in five patients. Two patients from the balloon group (25%) and 9 from the stent group (64%) are alive with patent veins at a median follow-up of 60 months, indicating a high attrition rate. Conclusion : Catheter interventions restored physiological blood flow in pediatric BCS. TH route improved cannulation of occluded HV compared to other accesses. Immediate and medium-term outcomes were better after stenting with lower rates of reinterventions than balloon angioplasty. Life-long surveillance is required as mortality is high on follow-up.http://www.annalspc.com/article.asp?issn=0974-2069;year=2023;volume=16;issue=3;spage=168;epage=174;aulast=Kodandaramabudd–chiari syndromeportal hypertensiontranshepatic access |
| spellingShingle | Usha Mandikal Kodandarama Sastry Madhu Swandenahalli Doddaiah Priyadarshini Arunakumar Varun Marimuthu Sowmya Kasturi Budnur C Srinivas Mahimarangaiah Jayranganath Cholenahally Nanjappa Manjunath Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center Annals of Pediatric Cardiology budd–chiari syndrome portal hypertension transhepatic access |
| title | Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center |
| title_full | Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center |
| title_fullStr | Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center |
| title_full_unstemmed | Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center |
| title_short | Percutaneous hepatic vein recanalization in pediatric Budd–Chiari syndrome – 10 years' experience from a tertiary center |
| title_sort | percutaneous hepatic vein recanalization in pediatric budd chiari syndrome 10 years experience from a tertiary center |
| topic | budd–chiari syndrome portal hypertension transhepatic access |
| url | http://www.annalspc.com/article.asp?issn=0974-2069;year=2023;volume=16;issue=3;spage=168;epage=174;aulast=Kodandarama |
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