title: Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava.
abstract: OBJECTIVE
  Budd-Chiari syndrome (BCS) is a clinical condition characterized by hepatic venous outflow obstruction. A transjugular intrahepatic portosystemic shunt (TIPS) is an effective means of decompressing the portal system in patients unresponsive to traditional medical therapy. TIPS may be difficult in patients with BCS owing to the presence of hepatic venous occlusive disease. We present our experience using direct percutaneous simultaneous puncture of the portal vein and the inferior vena cava to place a TIPS in patients with BCS.
  
  
  METHODS
  Between September 2003 and October 2006, percutaneous sonographically guided TIPS was performed on 11 patients (five women and a girl, four men and a boy; age range, 6-43 years). Indications for the TIPS procedure were intractable ascites in nine patients and intractable ascites and variceal bleeding in two patients.
  
  
  RESULTS
  Technical success was achieved in all patients. The mean portosystemic pressure gradient was reduced from 23.5 to 9.8 mm Hg. The cumulative rate of primary patency was 60% at 1 year. Nine revisions were performed in five patients. In nine of the 11 patients, ascites resolved completely, and in two patients, it was relieved.
  
  
  CONCLUSIONS
  Excellent technical and clinical success can be achieved with percutaneous sonographically guided direct simultaneous puncture of the portal vein and inferior vena cava in patients with BCS.
authors.affiliation: Radiology Department, Baskent University, Fevzi Cakmak Cad. 10. Sok. No. 45 06490, Ankara, Turkey. boyvatf@yahoo.com
authors.forename: Fatih
authors.initials: F
authors.lastname: Boyvat
authors.forename: Ali
authors.initials: A
authors.lastname: Harman
authors.forename: Umut
authors.initials: U
authors.lastname: Ozyer
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Aytekin
authors.forename: Zubeyde
authors.initials: Z
authors.lastname: Arat
mesh_terms: D000293:Adolescent; D000328:Adult; D001201:Ascites / Q000000981:diagnostic imaging / Q000601:surgery*; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D010690:Phlebography; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media