Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome.
OBJECTIVE
To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) for severe jaundice secondary to acute Budd-Chiari syndrome (BCS).


METHODS
From February 2009 to March 2013, 37 patients with severe jaundice secondary to acute BCS were treated. Sixteen patients without hepatic venule, hepatic veins (HV) obstruction underwent percutaneous angioplasty of the inferior vena cava (IVC) and/or HVs. Twenty-one patients with HV occlusion underwent TIPS. Serum bilirubin, liver function, demographic data and operative data of the two groups of patients were analyzed.


RESULTS
Twenty-one patients underwent TIPS and the technical success rate was 100%, with no technical complications. Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%. The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was 44.11±5.12 min (P<0.01). The mean portosystemic pressure in the TIPS group decreased significantly from 40.50±4.32 to 16.05±3.50 mmHg (P<0.01). The mean portosystemic pressure gradient decreased significantly from 33.60±2.62 to 7.30±2.21 mmHg (P<0.01). At 8 wk after the procedures, in the TIPS group, total bilirubin (TBIL) decreased significantly from 266.24±122.03 before surgery to 40.11±3.52 μmol/L (P<0.01) and direct bilirubin (DBIL) decreased significantly from 194.22±69.82 μmol/L to 29.82±3.10 μmol/L (P<0.01). In the angioplasty group, bilirubin returned to the normal range, with TBIL decreased significantly from 258.22±72.71 μmol/L to 13.33±3.54 μmol/L (P<0.01) and DBIL from 175.08±39.27 to 4.03±1.74 μmol/L (P<0.01). Liver function improved faster than TBIL. After 2 wk, in the TIPS group, alanine aminotransferase (ALT) decreased significantly from 50.33±40.61 U/L to 28.67±7.02 U/L (P<0.01) and aspartate aminotransferase (AST) from 49.46±34.33 U/L to 26.89±8.68 U/L (P<0.01). In the angioplasty group, ALT decreased significantly from 51.56±27.90 to 14.22±2.59 μmol/L (P<0.01) and AST from 60.66±39.89 μmol/L to 8.18±1.89 μmol/L (P<0.01). After mean follow-up of 12.6 mo, there was no recurrence of jaundice in either group.


CONCLUSIONS
Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Fu-Liang
FL
He
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Lei
L
Wang
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Hong-Wei
HW
Zhao
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Zhen-Hua
ZH
Fan
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Meng-Fei
MF
Zhao
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Shan
S
Dai
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Zhen-Dong
ZD
Yue
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Fu-Quan
FQ
Liu
D000208:Acute Disease; D000328:Adult; D017130:Angioplasty; D015415:Biomarkers / Q000097:blood; D006502:Budd-Chiari Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002681:China; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000503:physiopathology
D015415:Biomarkers
Budd-Chiari syndrome; Interventional therapy; Jaundice; Percutaneous angioplasty; Transjugular intrahepatic portosystemic shunt