Efficacy of Conventional Venography in Therapeutic Planning of Budd Chiari Patients

Background: Budd-Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction that involves one or more draining hepatic veins or IVC. Clinical manifestations in many cases are nonspecific, and imaging may be critical for early diagnosis of venous obstruction and accurate assessment of the extent of disease. If Budd-Chiari syndrome is not treated promptly and appropriately, the outcome may be dismal. Comprehensive imaging evaluations, in combination with pathologic analyses and clinical testing, are essential for determining the severity of disease, stratifying risk, selecting the appropriate therapy, and objectively assessing the response. The main goal of treatment is to alleviate hepatic congestion, thereby improving hepatocyte function and allowing resolution of portal hypertension. Various medical, endovascular, and surgical treatment options are available. Percutaneous and endovascular procedures, when performed in properly selected patients, may be more effective than medical treatment methods for preserving liver function and arresting disease progression in the long term. Objective: Evaluate efficacy of conventional venography in therapeutic planning and follow up of patients with Budd Chiari. Method(s): Sample size: Total of 65 patients were sequentially evaluated and followed up. Inclusion criteria – Patients with chronic liver disease and suspected to have hepatic venous outflow obstruction on MR venography of abdomen or on ultrasound porto-splenic Doppler. Exclusion criteria – Patients with a known liver disease (infective), inflammatory, CLD with good visualization of all 3 hepatic veins and IVC on imaging. Patients were evaluated with suspicious findings of Budd Chiari on colour Doppler and MR venogram. Further regular workup was done with PT/INR and HIV, HBsAg and HCV and posted for conventional venography with jugular puncture. Pigtail catheter run was taken of IVC and catheterization of the hepatic veins/collateral was attempted using 4 Fr head hunter or 4 Fr Cobra. Percutaneous puncture of hepatic vein/large collateral was also done using 22G Chiba needle. Result(s): Out of the 65 patients for whom conventional venography was done, 34 patients had evidence of lesions with the intra or infrahepatic portion of IVC causing IVC short or long segment narrowing with collaterals, 46 patients had lesions in left hepatic veins, 35 in middle hepatic vein and 33 in right hepatic vein. Only 70 % correlation could be found between MR venography of abdomen and conventional IVC gram studies. A decision for appropriate therapeutic management on basis of findings on conventional venography was then taken after discussion with gastro-enterology department. Patients were then regularly followed up every month clinically and using USG doppler. Conclusion(s): Conventional venography is a better imaging modality than Mr venography and doppler for evaluation and further planning of patients with Budd Chiari syndrome helping in decision making and follow-up.

Publication History

Article published online:
11 May 2021