Experience with mesocaval shunt with autologous jugular vein interposition in patients with Budd-Chiari syndrome.
OBJECTIVE
In the present era of interventional radiology and liver transplantation, the role of mesocaval shunt surgery for portal hypertension in Budd-Chiari syndrome is reviewed.


METHODS
This study analyzed the management of 35 patients with Budd-Chiari syndrome between June 1994 and June 2004 in our institution. During this 10-year interval, 31 of the 35 patients with Budd-Chiari syndrome underwent shunt procedures and four patients underwent liver transplantation. Mesocaval shunts were preferred in 27 patients and seven of these patients required prior caval stenting. One portocaval shunt was performed in a patient having a thrombosed mesocaval shunt. In all mesoaval shunt procedures the patient's internal jugular vein was used as an interposition graft between the superior mesenteric vein and inferior vena cava. In four patients with thrombosed vena cava a mesoatrial shunt was performed using polytetrafluoroethylene graft while four patients with established cirrhosis underwent orthotopic liver transplantation.


RESULTS
In the group of mesocaval shunts, 3 patients were lost in the early postoperative period with a mortality rate of 11%, 2 of them due to thrombosed shunts and one of them due to pneumonia. The median follow-up was 42 months (6-120 months) and one patient experienced shunt thrombosis and died afterwards due to the complications of portal hypertension. In the whole series the patency rate of the mesocaval shunt was 89%.


CONCLUSIONS
Patients with Budd-Chiari syndrome can be managed by a combination o f shuntsurgery, interventional radiology and liver transplantation. Our results demonstrate the effectiveness of mesocaval shunt procedure with autologous jugular vein interposition to maintain long-term patency and survival.
Ilkgul
Ozer
O
General Surgery Department, Celal Bayar University, School of Medicine, Manisa, Turkey. ilkgul@doctor.com
Kilic
Murat
M
Içöz
Gökhan
G
Zeytunlu
Murat
M
Demirpolat
Gulgun
G
Akyildiz
Mahir
M
Tokat
Yaman
Y
Parildar
Mustafa
M
Memis
Ahmet
A
D000328:Adult; D000714:Anastomosis, Surgical; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007601:Jugular Veins / Q000637:transplantation*; D008111:Liver Function Tests; D016031:Liver Transplantation; D018810:Magnetic Resonance Angiography; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D015642:Radiology, Interventional; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex; D014682:Vena Cava, Inferior / Q000601:surgery*