title: Transjugular intrahepatic portosystemic shunt by direct transcaval approach in patients with acute and hyperacute Budd-Chiari syndrome.
abstract: When Budd-Chiari syndrome (BCS) is due to occlusion of all three hepatic veins, the standard transjugular intrahepatic portosystemic shunt (TIPS) technique can be extremely laborious. A feasible alternative is to use the direct transcaval approach, by which a shunt can be created directly between the intrahepatic inferior vena cava and the portal vein. We describe two patients (one with acute BCS and one with hyperacute BCS) who were successfully managed with this modified technique. Both patients recovered; one of them underwent elective liver transplantation 15 months after the procedure, whereas the other still had good hepatic function and a patent stent 24 months after the procedure. We conclude that, in selected patients with acute and hyperacute BCS, placement of a TIPS by the direct transcaval approach is a rapid and effective emergency procedure, which can either be curative or function as a bridge for elective liver transplantation.
authors: Udine General Hospital, Division of Radiology, Vascular and Interventional Radiology Unit, Udine, Italy.
authors: Daniele
authors: D
authors: Gasparini
authors: Monica
authors: M
authors: Del Forno
authors: Massimo
authors: M
authors: Sponza
authors: Barbara
authors: B
authors: Branca
authors: Pierluigi
authors: P
authors: Toniutto
authors: Andrea
authors: A
authors: Marzio
authors: Mario
authors: M
authors: Pirisi
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011172:Portography