Short-segment (web-like) stenosis or occlusion of the hepatic veins or inferior vena cava is a recognised presentation of Budd-Chiari syndrome, encountered with particular frequency in Asian countries. When first-line mechanical recanalization does not achieve adequate restoration of hepatic blood flow, a structured next-line intervention is indicated.
This protocol addresses patients with Budd-Chiari syndrome in whom short-segment (web-like) stenosis or occlusion involves the hepatic veins or the inferior vena cava (IVC). The web-like morphology of these obstructions is a defining feature of this subgroup and, once diagnosed, warrants prompt action.
The preceding step was percutaneous transluminal balloon angioplasty with routine stent implantation — performed via transjugular, transfemoral, or percutaneous transhepatic access — aimed at recanalizing the short-segment occluded hepatic vein or IVC. The intended goal of that step — restoration of splanchnic and hepatic blood flow with clinical improvement and elimination of a significant pressure gradient across the stenosis — was not achieved. This protocol describes the recommended approach that follows.
The next step involves creation of a transjugular intrahepatic portosystemic shunt (TIPS) using a covered stent, sized to meet a defined minimum diameter requirement. In patients with additional vascular involvement, catheter-based measures targeting sustained vascular patency may be incorporated alongside the shunt procedure.
Clinical targets include meaningful reduction of the portosystemic pressure gradient and improvement in renal function within two weeks. The complete protocol — procedural detail, access strategy, and supplementary measures — is available via the link below.
DOI: 10.3390/diagnostics13081458
Short-segment stenosis or the occlusion (the so-called web) of hepatic veins or the inferior vena cava are frequent in Asian countries.
Angioplasty should be performed without delay if a web-like BCS has been diagnosed.
It is strongly recommended to create a shunt with a diameter of at least 10 mm to achieve sufficient shunt flow and to relieve hepatic and intestinal congestion.
Needless to say, only 10 mm PTFE-covered stents should be utilized to optimize flow and long-term patency.
The TIPS reduced the pressure gradient to 10.8 ± 4.9 mmHg.
With respect to the systemic circulation, the TIPS improved the creatinine concentration within 2 weeks from 1.9 ± 1.7 to 0.8 ± 0.4 mg/dL.
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