TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy

Abstract

Patients with Budd-Chiari syndrome (BCS) may require treatment with portal decompressive surgery or liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) represents a new treatment alternative, but its long-term effect on BCS outcome has not been evaluated. Twenty-one patients with BCS consecutively admitted to our unit were evaluated. The mean follow-up was 4 ؎ 3 years. Seven patients had nonprogressive forms and were successfully controlled with medical therapy; 1 case, with a short-length hepatic vein stenosis was successfully treated by angioplasty. All 8 patients are alive and asymptomatic. The remaining 13 patients, had a TIPS because of clinical deterioration (in one of them, because early TIPS thrombosis a successful side-to-side portacaval shunt [SSPCS] was performed) followed by an improvement in clinical condition. However, a patient with fulminant liver failure before TIPS insertion, died 4 months later and another patient with cirrhosis at diagnosis had liver transplantation 2 years later. The remaining 11 patients are alive and free of ascites. In 3 of these patients TIPS is patent after 3, 6, and 12 months. The remaining 8 patients developed late TIPS dysfunction. In two of these cases, after angioplasty and restenting, TIPS is patent after a follow-up of 9 and 80 months. In 5 other patients, recurring TIPS occlusion was not further corrected because no signs of portal hypertension were present. In conclusion, in patients with BCS uncontrolled with medical therapy, TIPS is a highly effective technique that is associated with long-term survival. (HEPATOLOGY 2002;35: 132-139.)

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

“…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.…”

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

“…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] .…”

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

“…TIPS has been shown to be effective as the treatment for BCS in early experiences [21][22][23] and can be successful also in the technically difficult case of extension of thrombosis to the portal vein tree [24,25] . Moreover, a multi-center experience provided long-term data on TIPS treatment for 147 BCS patients not responding to medical treatment or recanalization.…”