Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava.
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.
Boyvat
Fatih
F
Radiology Department, Baskent University, Fevzi Cakmak Cad. 10. Sok. No. 45 06490, Ankara, Turkey. boyvatf@yahoo.com
Harman
Ali
A
Ozyer
Umut
U
Aytekin
Cuneyt
C
Arat
Zubeyde
Z
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
D003287:Contrast Media