Acute Budd-Chiari syndrome with liver failure: the experience of a policy of initial interventional radiological treatment using transjugular intrahepatic portosystemic shunt.
OBJECTIVE
The optimal management of acute Budd-Chiari syndrome (BCS) with liver failure is controversial. Options include anticoagulation, portal systemic shunting or liver transplantation. In recent years, transjugular intrahepatic portosystemic shunts (TIPS) have been tried in place of shunt surgery. We report our experience with a policy of initial interventional radiological treatment (TIPS) in this patient group.


METHODS
A consecutive, non-selected series of five patients with acute BCS with liver failure presenting to our liver unit over a 36-month period from October 2000 were treated with a policy of initial attempt at transjugular shunt.


RESULTS
Stents were successfully inserted in four patients. In one patient the hepatic vein remnant could not be cannulated. One of the four stented patients had a hepatic venous web. Rapid recurrent portal and hepatic vein thrombosis occurred in one patient despite anticoagulation and trans-shunt thrombectomy. This patient and the patient with failed stenting underwent successful liver transplantation. One successfully stented patient died unexpectedly at home 2 weeks after TIPS insertion. Four of five patients are alive (80%) at a mean follow-up time of 30 months.


CONCLUSIONS
Initial TIPS, with liver transplantation for treatment failures, may be a reasonable, cost-effective and surgery-sparing treatment for acute Budd-Chiari presenting with liver failure.
Kavanagh
Paul M
PM
National Liver Transplant Unit, St Vincent's University Hospital Elm Park and University College, Dublin, Ireland.
Roberts
Jaqueline
J
Gibney
Robin
R
Malone
Dermot
D
Hegarty
John
J
McCormick
P Aiden
PA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015642:Radiology, Interventional; D016896:Treatment Outcome