SIR 2024
Portal Hypertension
Anne Sailer, MD
Vascular/Interventional Radiology Resident
Yale University
Financial relationships: Full list of relationships is listed on the CME information page.
Angelo G. Marino, DO
Assistant Professor
Yale University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Todd Schlachter, MD
Professor of Radiology and Biomedical Imaging
Yale University
Financial relationships: Full list of relationships is listed on the CME information page.
1. Budd-Chiari syndrome (BCS) is the occlusion of one or more veins of the liver due to various disorders that result in sinusoidal congestion, portal hypertension, fibrosis, cirrhosis, and nodular regeneration.
2. The new BCS classifications can provide more appropriate treatment options; accurately determining the type of obstructor, number of blocked vessels, and length of the obstruction and categorizing the patients according to the updated BCS classification can improve the success of the patient’s therapeutic treatment plan.
Background:
Recent studies introduce new BCS classifications that can distinguish patients better and provide more appropriate treatment options. Accurately determining the type of obstructor, the number of blocked vessels, length of the obstruction, and categorizing the patients according to the updated BCS classifications can improve the success of the therapeutic plan.
Local and systemic thrombolysis and angioplasty can be initial treatments for patients with short segment involvement. IVUS is essential in determining the length of segment involved. Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used in patients with a long segment involved or cases that did not respond to angioplasty. If TIPS fails, the next plan is a liver transplant.
Clinical Findings/Procedure Details:
1. Review pathophysiology of Budd Chiari and the BCS classifications.
2. Briefly review potential mimics of Budd Chiari (i.e. other cause of sinusoidal or post hepatic obstruction).
2. Discuss general concepts of assessing the liver Doppler US, CTA, MRA, venography, and intravascular ultrasound (IVUS) with emphasis on technique, protocol, and image optimization for diagnosing Budd Chiari.
a. Describe differentiating imaging features of various BCS presentations depending on the location of the occlusion.
b. Review complications associated with BCS.
c. Briefly demonstrate pitfalls of BCS.
4. Discuss management options with interventional radiology procedures (venoplasty and stenting, local pharmacologic and mechanical thrombolysis, transjugular intrahepatic portosystemic shunt (TIPS) placement), and potential complications.
Conclusion and/or Teaching Points: The new BCS classifications can provide more appropriate treatment options; accurately determining the type of obstructor, number of blocked vessels, and length of the obstruction and categorizing the patients according to the updated BCS classification can improve the success of the patient’s therapeutic treatment plan.