Endovascular Management of Budd Chiari Syndrome - A Case Report

Background: Budd Chiari Syndrome denotes a group of rare diseases which have been studied with considerable interest by clinicians across the world. The clinical presentation and investigation results vary in most cases making the diagnosis a challenge. Although the treatment protocols are published in literature, much of it comes from expert opinions rather than research-based findings. The use of medical therapy, thrombolysis and interventional procedures are well known. However, the order of preference while choosing the treatment option depends on each case and must be considered depending on local expertise.

Case Summary: We present a case of a young male patient with no significant medical history who presented with lower limb oedema and pain. The laboratory findings were within normal range and the ultrasound scan revealed mild hepatomegaly. On further imaging we found a retrohepatic vena caval occlusion which was amenable to endovascular intervention. This patient was treated with angioplasty and stenting with satisfactory clinical outcome. The decision to proceed with an endovascular first approach is highlighted in our case report.

Conclusion: The traditional treatment strategies for BCS include medical therapy, thrombolysis or surgical portosystemic shunt creations which involve significant morbidity and procedure related complications. It is worthwhile to select patients with amenable lesions to undergo endovascular treatment in the initial stages of management. This will lead to good clinical outcomes and prevent long term liver damage. This approach has been highlighted in our case report and we recommend its use with the availability of local expertise.