Percutaneous transhepatic hepatic venography in the delineation and treatment of Budd-Chiari syndrome

PURPOSE: To assess the usefulness of percutaneous transhepatic hepatic venography (PTHV) in planning interventional radiologic treatment of Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Six patients aged 14-56 years underwent examination for BCS. After preliminary transfemoral inferior vena cavography and selective hepatic venography failed in determining the extent of venous obstruction, PTHV was performed. RESULTS: PTHV completely depicted the proximal and distal extent of hepatic venous occlusion. Intraluminal thrombus in the right and middle hepatic veins shown in one patient was treated with fibrinolytic infusion and balloon thrombectomy. Central obstruction of the right hepatic vein shown in two patients was treated with venoplasty or venoplasty and stent placement. In three patients, PTHV showed a ''spider web'' appearance of diffuse obliteration of the normal intrahepatic venous architecture; a transjugular intrahepatic portosystemic shunt was placed in two of these patients. CONCLUSION: PTHV provides information not available with conventional venography that is useful in planning the treatment of BCS.