Radical surgery for Budd-Chiari syndrome. Direct excision and repair for obstruction of the vena cava (Budd-Chiari syndrome) under hepatic vascular exclusion using a centrifugal pump.

OBJECTIVE: To attempt to reduce the incidence of hepatic and cardiac failure after radical surgery for the Budd-Chiari syndrome. DESIGN: Retrospective case study. SETTING: University hospital, Japan SUBJECTS: Three patients with obstruction of the vena cava (Budd-Chiari syndrome) by a thick membrane, thrombus, and a long stenosis, respectively. INTERVENTION: Direct excision and repair by patch dilatation under hepatic vascular exclusion using a Biomedicus centrifugal pump. RESULTS: Hepatic vascular exclusion provides good visibility and enables accurate assessment of the obstruction, proper treatment, and relatively little blood loss. There were no complications, particularly liver failure or heart failure, and the inferior vena cava stayed patent in all cases. Liver function was improved in all three patients. CONCLUSION: This technique is safe and reliable for removal of obstruction of the inferior vena cava (Budd-Chiari syndrome).