Portosystemic shunt in Budd-Chiari syndrome: long-term survival and factors affecting shunt patency in 25 patients in Western countries.
BACKGROUND
In Budd-Chiari syndrome (BCS) treated by portosystemic shunt, postoperative shunt thrombosis is associated with high morbidity and mortality rates. The aim of this study was to determine factors associated with shunt thrombosis.


METHODS
From 1985 to 1991, 25 patients underwent portosystemic shunt for BCS. According to the patency of the shunt during the postoperative period and follow-up, patients were divided into two groups including 17 patients with patent shunt and 8 (32%) with shunt thrombosis.


RESULTS
In patients with patent shunt, actuarial survival rate at 5 years was 87% versus 38% in patients with shunt thrombosis (p < 0.05). Duration of symptoms before operation was higher in patients with shunt thrombosis than in patients with patent shunt (315 +/- 483 vs 109 +/- 168 days, p < 0.05). In patients with patent shunt, extensive fibrosis or cirrhosis was observed in 3 of 17 (18%) versus in 5 of 8 (63%) of patients with shunt thrombosis (p < 0.05). Shunt thrombosis was observed in 3 of 3 patients (100%) with the combination of myeloproliferative disorder, duration of symptoms more than 100 days, and cirrhosis versus 0 of 6 (0%) patients without this combination (p < 0.05).


CONCLUSIONS
In acute form of BCS (with short history of the disease and absence of extensive fibrosis or cirrhosis), early portal decompression is mandatory, with low risk of shunt thrombosis and good long-term results. In chronic form of BCS, the risk of shunt thrombosis is high and long-term results are bad; in these patients, orthotopic liver transplantation must be considered.
Panis
Y
Y
Service de Chirurgie Digestive et d'Hépatologie, Université Paris VII, Hôpital Beaujon, Clichy-Paris, France.
Belghiti
J
J
Valla
D
D
Benhamou
J P
JP
Fékété
F
F
D000206:Actuarial Analysis; D000328:Adult; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D008297:Male; D009196:Myeloproliferative Disorders / Q000150:complications; D011170:Portasystemic Shunt, Surgical / Q000401:mortality*; D015996:Survival Rate; D017741:Survivors; D014654:Vascular Patency