[Transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome with extensive occlusion of the hepatic veins].
OBJECTIVE
To explore the outcome of a transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of 11 patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins.


METHODS
Eleven patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins were elected for TIPS. Three patients had a acute; eight, a subacute or a chronic course of the disease. All patients were associated with variceal bleeding and massive ascites. The diagnosis of Budd-Chiari syndrome was established by duplex-sonography, CT, MRI, upper digestive barium meal, angiography of hepatic veins and IVC, and liver biopsy. The shunt with diameter of 10 cm was established between the inferior caval vein and the intrahepatic portal vein with self-expandable stents in all patients. The mean follow-up was 63 +/- 43 months.


RESULTS
The shunt reduced the portasystemic pressure gradient from 41.2 +/- 10.5 to 12.4 +/- 4.7 cm H2O and improved the portal flow velocity from 11.2 +/- 2.8 to 52.2 +/- 13.7 cm/s. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after shunt treatment. Ten patients are alive without clinical symptoms except one death due to hepatic failure. Revision in 2 patients was needed during the follow-up. The inflation of stenosing shunt was performed in 1 patient, and the reimplantation of stent in another patient. Eight patients had no revisions.


CONCLUSIONS
TIPS provided an excellent outcome in patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins. It might be regarded as a treatment for the acute and long-term management of these patients.
Wu
Xing-jiang
XJ
Research Institute of General Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China. wxj_wxj@sohu.com
Cao
Jian-min
JM
Han
Jian-ming
JM
Li
Jie-shou
JS
D000208:Acute Disease; D000328:Adult; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D016896:Treatment Outcome