Management of hepatic venous outflow obstruction

Kohli, Vijay; Pande, Girish; Reddy, K. Srinath; Nundy, Samiran; Dev, V.; Kaul, Upendra

doi:10.1016/0140-6736(93)91712-u

Cited by 99 publications

(99 citation statements)

References 23 publications

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“…All previous Indian series, except two [29,32] , describe the predominance of IVC up to 79.2% [7,9,[11][12][13]15,30,39,40,42] or IVC-HV obstruction up to 57.7% [14,24,25,35] ; HV involvement was described in 0%-32% of cases in these series [7,9,[11][12][13][14][15]24,25,30,35,39,40,42] . Of the two distinct previous series, one (total 53 cases) showed similar frequency of HV (35.8%), IVC (33.9%) and combined IVC-HV involvement (30.1%) [29] ; whereas the other series involving only chronic BCS showed predominance of HV (45.9%) followed by combined IVC-HV (29.7%) and IVC involvement (24.3%) [32] .…”

Section: Discussionmentioning

confidence: 99%

“…Previously, MOVC was thought to be the predominant cause of IVC involvement (20.4%-58.6%) and of BCS in India [6,7,[11][12][13][14][15]17,29,35,39] , as well as in Asian countries [49,50,53] . In two recent Indian studies, MOVC was present in 0% and 17.2%, while IVC involvement was seen in 56.2% and 62% cases, respectively [24,40] .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the western world, in the Indian series, there is a striking predominance of IVC obstruction (mainly from membrane or web) or combined IVC-HV obstruction rather than HV obstruction alone [12][13][14][15] . Tumors, pregnancy, oral contraceptive pills (OCP) and infections were proposed as predominant underlying etiologies, hypercoagulable states were uncommon, and idiopathic cases were the most common [9,[12][13][14][15][16][17][18][19][20][21]42] . In the series of cases during the last 10 years, various hypercoagulable states are being increasingly described as etiologies of BCS [24][25][26][28][29][30]46,47] .…”

Section: Introductionmentioning

confidence: 99%

“…The majority of patients with BCS present with a chronic course, while only a small number of patients present with acute or fulminant forms [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . BCS is mostly encountered in the adult population and considered uncommon in children; when seen in children, the clinical presentation is similar [13] .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Amarapurkar¹,

Punamiya²,

Patel³

2008

WJG

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“…7,16 This could be because in recent years, improvement in availability and techniques of diagnostic tools has contributed to earlier recognition of BCS patients. 19,24 Furthermore, most of our patients were treated with anticoagulants, which, in addition to better identification of underlying prothrombotic factors, 22 has been reported to contribute to the improvement in prognosis of BCS. 16 The aim of the present study was to assess prognostic determinants of survival in BCS patients.…”

Section: Discussionmentioning

confidence: 99%

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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Management of idiopathic obstruction of the hepatic and suprahepatic inferior vena cava with a self-expanding metallic stent

Kaul

Agarwal

Jain

et al. 1996

Cathet. Cardiovasc. Diagn.

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Management of hepatic venous outflow obstruction

Cited by 99 publications

References 23 publications

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

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

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

Management of idiopathic obstruction of the hepatic and suprahepatic inferior vena cava with a self-expanding metallic stent

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