Budd-Chiari syndrome: technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt.

Blum, Ulrich; Rössle, Martin; Haag, K.; Ochs, Andreas; Blum, HE; Kh, Hauenstein; Astinet, F.; Langer, Martin

doi:10.1148/radiology.197.3.7480760

Cited by 136 publications

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“…Other recent studies have demonstrated positive results of this new approach in terms of short-term survival. 12,13,26 TIPS is less invasive and therefore probably associated with a lower procedural mortality than PSS. 27 Long-term follow-up studies are needed to assess the place of TIPS in the treatment of BCS.…”

Section: Discussionmentioning

confidence: 99%

“…5,8 Main treatment options include the long-term use of anticoagulants, surgical portosystemic shunting (PSS), 9 -11 transjugular intrahepatic portosystemic shunting (TIPS), 12 and orthotopic liver transplantation. 13 Other treatment methods are thrombolysis 14 and percutaneous hepatic vein balloon angioplasty. 15 Several studies have been published on the cause, clinical manifestations, prognosis, and interventions in BCS.…”

Section: Bcsmentioning

confidence: 99%

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Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome

et al. 2004

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Budd-Chiari syndrome (BCS) is a rare disorder that is characterized by hepatic venous outflow obstruction. The aim of this study was to assess determinants of survival and to evaluate the effect of portosystemic shunting. In this international multicenter study, 237 patients with BCS, diagnosed between 1984 and 2001, were investigated. Univariate, multivariate, and time-dependent Cox regression analyses were performed. Overall survival at 1, 5, and 10 years was 82% (95% CI, 77%-87%), 69% (95% CI, 62%-76%), and 62% (95% CI, 54%-70%), respectively. Encephalopathy, ascites, prothrombin time, and bilirubin were independent determinants of survival. A prognostic classification combining these factors could identify three classes of patients (classes I-III). The 5-year survival rate was 89% (95% CI, 79%-99%) for class I, 74% (95% CI, 65%-83%) for class II, and 42% (95% CI, 28%-56%) for class III. Anticoagulants were administered to 72%; only for patients in class I was this associated with a trend toward improved survival (relative risk [

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Section: Discussionmentioning

confidence: 99%

Section: Bcsmentioning

confidence: 99%

Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome

et al. 2004

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“…In the last decade, the use of TIPS in BCS is increasingly described in the world literature [81][82][83][84][85][86][87][88][89][90][91][92][93][94] . In cases with severe liver dysfunction requiring liver transplantation, TIPS used as an interim bridge to transplantation, can improve the situation dramatically [4] .…”

Section: Discussionmentioning

confidence: 99%

“…Difficulty with TIPS may be associated splanchnic venous thrombosis, which can be successfully tackled by radiological interventions in the same session [89] . Technical success for TIPS ranges from 75% to 100% in various works [ of TIPS dysfunction (present in 40% to 75% if followed up for more than two years [80,82,84,90,91,93] ) necessitates reinter vention in up to 70% of cases [1,[87][88][89]91] , giving a revision rate of 1.4 revisions per patient [91] . TIPS related complications occur in less than 20% of patients [91] .…”

Section: Discussionmentioning

confidence: 99%

Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment

Amarapurkar¹,

Punamiya²,

Patel³

2008

WJG

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AIM:To evaluate patterns of obstruction, etiological spectrum and non-surgical treatment in patients with Budd-Chiari syndrome in India. METHODS:Forty-nine consecutive cases of BuddChiari syndrome (BCS) were prospectively evaluated. All patients with refractory ascites or deteriorating liver function were, depending on morphology of inferior vena cava (IVC) and/or hepatic vein (HV) obstruction, triaged for radiological intervention, in addition to anticoagulation therapy. Asymptomatic patients, patients with diuretic-responsive ascites and stable liver function, and patients unwilling for surgical intervention were treated symptomatically with anticoagulation. RESULTS:Mean duration of symptoms was 41.5 ± 11.2 (range = 1-240) mo. HV thrombosis (HVT) was present in 29 (59.1%), IVC thrombosis in eight (16.3%), membranous obstruction of IVC in two (4%) and both IVC-HV thrombosis in 10 (20.4%) cases. Of 35 cases tested for hypercoagulability, 27 (77.1%) were positive for one or more hypercoagulable states. Radiological intervention was technically successful in 37/38 (97.3%): IVC stenting in seven (18.9%), IVC balloon angioplasty in two (5.4%), combined IVC-HV stenting in two (5.4%), HV stenting in 11 (29.7%), transjugular intrahepatic portosystemic shunt (TIPS) in 13 (35.1%) and combined TIPS-IVC stenting in two (5.4%). Complications encountered in follow-up: death in five, re-stenosis of the stent in five (17.1%), hepatic encephalopathy in two and hepatocellular carcinoma in one patient. Of nine patients treated medically, two showed complete resolution of HVT. CONCLUSION:In our series, HVT was the predominant cause of BCS. In the last five years with the availability of sophisticated tests for hypercoagulability, etiologies were defined in 85.7% of cases. Non-surgical management was successful in most cases.

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“…A possible radiological intervention in these patients consists of creating a shunt across the portal vein and IVC. With a relatively good midterm outcome, currently TIPS is the preferred intervention for patients having chronic BCS [23][24][25][35][36][37][38][39][40][41] . Creating TIPS in patients having chronic BCS with no available hepatic vein may be technically challenging and difficult and in some cases there may not even be a small notch in the IVC to suggest the site of confluence of hepatic vein and IVC.…”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

Imaging and interventions in Budd-Chiari syndrome

Mukund

Gamanagatti²

2011

WJR

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Budd-Chiari syndrome (BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension. Clinically, two forms of disease (acute and chronic) are recognized. Mostly the patients present with ascites, hepatomegaly, and portal hypertension. In acute disease the liver is enlarged with thrombosed hepatic veins (HV) and ascites, whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava (IVC), or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC. Due to advances in radiological interventional techniques and hardware, there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation. The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS.

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Budd-Chiari syndrome: technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt.

Abstract: TIPS placement is safe and effective in patients with portal hypertension caused by subacute or chronic BCS.

Cited by 136 publications

References 0 publications

Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome

Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome

Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment

Imaging and interventions in Budd-Chiari syndrome

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