Endovascular treatment of symptomatic Budd–Chiari syndrome – in favour of early transjugular intrahepatic portosystemic shunt

Either acute or sub-acute Budd–Chiari syndrome (BCS) with diffuse occlusion of hepatic veins has a high mortality rate and remains challenging for clinical treatment. We aimed to evaluate the feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for BCS with diffuse occlusion of hepatic veins. From January 2007 to December 2010, 100 patients were randomly recruited onto this study and 91 patients were treated with TIPS. 14 patients were defined as acute BCS group and 86 patients as sub-acute group. Patients with acute BCS had a significantly higher rate of jaundice whereas a lower rate of abdominal and chest varices, gastroesophageal variceal bleeding and refractory ascites than sub-acute group (P < 0.001). TIPS was technically successful in all 91 patients (12 in acute group). The portosystemic pressure gradient (PSG) was decreased to normal level, while total bilirubin (TBIL) and liver function were significantly improved. During follow-up period, the mortality rate of 91 patients who underwent TIPS was 6.59% (6/91), whereas 88.89% of 9 patients who didn’t receive TIPS procedure (2 in acute group). Collectively, TIPS is an effective and safe approach in treating BCS with diffuse occlusion of hepatic veins, which should be performed in time.

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“…BCS affects younger to mid-aged patients with the mean age of 40 y/o6. Clinical symptoms of BCS vary greatly depending on the course of disease.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt for Budd–Chiari syndrome with diffuse occlusion of hepatic veins

Zhao

Dai

et al. 2016

Sci Rep

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“…HV occlusive BCS is difficult to diagnose and often mistaken for hepatic cirrhosis, liver carcinoma, or BCS with IVC occlusion. Recently, HV angioplasty, transjugular intrahepatic portosystemic shunt (TIPS), and modified TIPS have become the main treatments for HV occlusive BCS [3][4][5]. Rapid and effective recovery of HV and portal vein (PV) blood flow can promote the control of bleeding and ascites as well as the recovery of liver function.…”

Section: Introductionmentioning

confidence: 99%

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

et al. 2016

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“…Recently, some confirmation about the opportunity of early TIPS for BCS has been reported [49,50] . In fact, a group from China reported data on 100 patients with BCS with diffuse occlusion of HVs out of 377 BCS from January 2007 to December 2010.…”

Section: Early Versus Delayed Interventional Treatment Of Bcsmentioning

confidence: 96%

“…Both one-and five-year transplantfree survival was 100% and 93%, respectively. The authors concluded that TIPS is a safe and effective treatment for symptomatic BCS and should be considered the firstline intervention in patients with insufficient response to medical treatment [50] .…”

Section: Early Versus Delayed Interventional Treatment Of Bcsmentioning

confidence: 99%

Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: An Italian hepatologist’s perspective

Mancuso

2017

Journal of Translational Internal Medicine

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Budd-Chiari syndrome (BCS) management flow-chart is derived from experts' opinion and is not evidence-based. Guidelines suggest BCS management should follow a stepwise strategy: medical therapy as first-line treatment, revascularization or transjugular intrahepatic portosystemic shunt (TIPS) if no response to medical therapy, and liver transplant as rescue therapy. Recent evidence suggests that only medical therapy results in a bad long-term outcome. The biggest criticism of guidelines is the indication that BCS should receive further treatment only when hemodynamic consequences of portal hypertension become clinically evident. Recent data support that in BCS liver fibrosis could arise from chronic microvascular ischemia. A reasoning model of BCS physiopathology is that impaired hepatic vein outflow has hemodynamic consequences on portal hypertension development and causes hepatic fibrosis and liver failure through chronic ischemic damage. On this assumption is the concept that relieving liver congestion could ameliorate liver function and prevent development of BCS complications. Recently, early interventional treatment with TIPS for BCS has been reported to be effective. Early TIPS seems to be the best option for BCS management. Future multicenter controlled studies should compare the outcome of BCS treated with early interventional treatment compared with stepwise strategy.

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Endovascular treatment of symptomatic Budd–Chiari syndrome – in favour of early transjugular intrahepatic portosystemic shunt

Cited by 34 publications

References 22 publications

Transjugular intrahepatic portosystemic shunt for Budd–Chiari syndrome with diffuse occlusion of hepatic veins

Transjugular intrahepatic portosystemic shunt for Budd–Chiari syndrome with diffuse occlusion of hepatic veins

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: An Italian hepatologist’s perspective

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