Accessory hepatic vein recanalization: a viable approach in hepatic vein outflow tract obstruction

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OBJECTIVE: To evaluate the mid- and long-term outcome of recanalization of accessory hepatic vein (AHV) secondary to hepatic venous outflow obstruction and to compare the mid- and long-term outcome and technical efficacy and safety of AHV recanalization with native hepatic vein (HV) recanalization in hepatic vein outflow tract obstruction (HVOTO) patients. METHODS: This retrospective observational study, conducted at a single-centre, evaluated the mid- and long-term outcomes of AHV recanalization compared to native HV recanalization in 170 HVOTO patients treated between January 2013 and October 2020. RESULTS: Patients were divided into 2 groups based on the type of recanalization performed: AHV (n = 26) and native HV (n = 144). Technical success was achieved in 100% of AHV cases and 95.8% of native HV cases. The primary patency rates at 1, 3, and 5 years were 95.9%, 92.3%, and 76.9% for AHV and 96.5%, 93%, and 79.1% for native HV, respectively. Significant improvements in liver stiffness, clinical symptoms, and hepatic function were observed post-intervention in both groups, with no significant differences in outcomes. Transplant-free survival rates at 1, 3, and 5 years were also comparable between groups. CONCLUSION: This study demonstrates that AHV recanalization is a safe and effective alternative to native HV recanalization, providing comparable long-term outcomes. ADVANCES IN KNOWLEDGE: It offers a promising option for HVOTO patients with dominant AHV and extensive intrahepatic collaterals, further supporting its integration into the stepwise management of HVOTO.

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