CLINICAL SPECTRUM AND OUTCOMES OF ENDOVASCULAR INTERVENTION IN CHRONIC BUDD–CHIARI SYNDROME: EXPERIENCE FROM A TERTIARY CARE CENTRE IN SOUTH INDIA

Objective &Aim: This study aimed to evaluate the clinical spectrum and outcomes of Endovascular interventions in patients with Chronic BuddChiari Syndrome (CSBS) treated at a tertiary care centre in South India. Methods: A total of 45 consecutive patients with CBCS were prospectively evaluated. Patients presenting with abdominal pain, ascites, jaundice, upper gastrointestinal bleeding or worsening liver function were included. Based on the site of venous obstruction- Hepatic vein (HV), Inferior vena cava (IVC), or Combined IVC and HV-patients underwent endovascular interventions with anticoagulation therapy. Technical success, clinical success, reintervention rate, mortality rate and need for liver transplantation were analysed for a period of 6 months. Results: Of the 45 patients, 10 (22.2%) had isolated IVC obstruction, 15 (33.3%) had HV obstruction, and 20 (44.4%) had combined IVC and HV obstruction. Interventions included IVC angioplasty (n=9), IVC angioplasty with stenting (n=1), HV angioplasty (n=5), HV stenting (n=7), combined IVC and HV angioplasty (n=9), combined stenting (n=2), and Direct Intrahepatic Portosystemic Shunt (DIPS) (n=12). Technical success was achieved in 44 patients (97.8%), and clinical success in 37 (82.2%). Complications occurred in 9 patients (19.9%), and Reintervention was required in 5 patients (11%). Two patients (4.4%) required liver transplantation and overall mortality was 1 (2.2%) within 6 months. Conclusion: Combined IVC and HV obstruction was the predominant pattern of obstruction in this study. Endovascular intervention demonstrated high technical and clinical success with low morbidity and mortality, supporting its role as an effective denitive treatment and bridge to liver transplantation in chronic Budd–Chiari syndrome