Transient elastography may be effective in evaluating endovascular treatment of Budd-Chiari syndrome

1. In a retrospective study of 25 patients with Budd-Chiari syndrome (BCS) treated with endovascular interventions, the decrease in liver stiffness (LS) observed on transient elastography (TE) corresponded with the resolution of ascites and improved liver function.

Evidence Rating Level: 3 (Average)       

Study Rundown: BCS is a condition characterized by hepatic venous outflow obstruction, which can result in hepatic cell inflammation and fibrosis. The goal of treatment for BCS is to reduce hepatic congestion by relieving venous obstruction. Primary management modalities include endovascular therapies such as stenting or angioplasty. The effectiveness of endovascular treatment was traditionally measured by pressure gradient across the hepatic vein stenosis. The purpose of this article was to assess the ability of TE as a non-invasive modality to assess the effectiveness of endovascular treatment of BCS.

This study retrospectively evaluated the use of TE in assessing LS in patients with BCS treated with endovascular therapy. At the conclusion of the study, the majority of patients demonstrated resolution of hepatic congestion and ascites post-endovascular intervention. LS was significantly reduced within 24 hours and 3 months after the procedure compared to the LS prior to the procedure. These findings demonstrate that TE may serve as a useful noninvasive tool to assess hepatic congestion after endovascular treatment in BCS. This study is strengthened by the exclusion of patients with confounding factors that affect LS such as cholestasis, obesity, metabolic syndrome, and liver lesions. However, the study is limited by small study population, the simultaneous evaluation of multiple different endovascular interventions, and inconsistency with respect to the location of LS measurements in individual patients and among all patients. Larger, prospective multicenter trials where individual interventions can be independently evaluated over a longer duration may improve the interpretability of these findings.

Click to read the study in JVIR

Relevant Reading: Long-term outcomes following percutaneous hepatic vein recanalization for Budd–Chiari syndrome

In-Depth [prospective cohort]: This study retrospectively assessed LS by TE in patients with BCS who underwent endovascular treatment. Overall, this study recruited 25 patients with BCS, 12 of which underwent liver biopsy before the procedure to determine fibrosis via the METAVIR scoring system. Two operators performed TE in all patients via a FibroScan ultrasound unit. Differences in LS measurements before and after the procedure were assessed by Wilcoxon signed-rank test. Differences in LS measurements between patients with METAVIR fibrosis scores ≤ 2 (n = 7) and >2 (n = 5) were compared via Mann–Whitney U test. There was a statistically significant reduction in LS less than 24 hours post-treatment compared to pre-treatment (26.31 vs. 62.78 kPa; p < 0.0001). There was a statistically significant reduction in LS 3 months post-treatment compared to pre-treatment (20.95 vs. 62.78 kPa, p < 0.001). There was no statistically significant difference in LS between patients with METAVIR fibrosis score ≤ 2 and > 2 after intervention (42.6 vs. 49.64 kPa).

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