Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Kulkarni, Chinmay Bhimaji; Moorthy, Srikanth; Pullara, Sreekumar Karumathil; Prabhu, Nirmal Kumar; Kannan, Ramiah Rajesh; Nazar, Puthukudiyil Kader

Abstract

BACKGROUND
To compare the outcomes in a group of patients with Budd-Chiari syndrome (BCS) managed by percutaneous recanalization with a group of patients who were managed by medical therapy alone.
METHODS
We retrieved the hospital records of 37 patients with BCS admitted to our facility between 2004 to 2017 and identified 24 patients (male:female = 10:14; mean age, 32.7 ± 12.5 years) who underwent percutaneous recanalization. Remaining thirteen patients (male:female = 3:10; mean age, 36.77 ± 14.71 years), were managed by medical therapy. Technical and clinical results, complications, and primary patency of percutaneous recanalization were analyzed. Overall and symptom-free survival rates, the frequency of symptom recurrence, and the number of readmissions for recurrent symptoms were analyzed in both interventional treatment and medical therapy groups.
RESULTS
Technical success for recanalization of hepatic vein/inferior venecava by angioplasty ± stenting was achieved in 22 patients (22/24, 91.7%). Clinical success was achieved in 19 patients (19/24, 79.2%). Overall survival for patients who underwent percutaneous recanalization at 1 year and five years was 87.0% and 87.0% and for patients with medical therapy was 90.1% and 45.5%, respectively (P = 0.710). Symptom-free survival for patients who underwent percutaneous recanalization at 1 year and five year was 93.3% and 81.7% and for patients with medical therapy was 26.0% and 0%, respectively (P < 0.001). In the intervention group, 4 patients (4/24, 16.7%) were admitted for recurrent symptoms (median number of readmissions 1, range: 1-2) whereas in medically managed patients 9 patients (9/13, 69.2%) were readmitted (median number of readmissions, 2; range, 1-5) (P = 0.003).
CONCLUSION
There was no statistically significant difference in overall survival of patients managed with percutaneous recanalization and medical therapy. Percutaneous recanalization had definite benefit in terms of fewer recurrent symptoms and hospital admissions, hence should be performed whenever technically feasible.