Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome

Ochs, Andreas; Sellinger, M.; Haag, K.; Nöldge, G.; Herbst, E. W.; Walter, Elke; Gerok, W.; Rössle, Martin

doi:10.1016/s0168-8278(05)80249-1

Cited by 132 publications

(55 citation statements)

References 32 publications

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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%

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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%

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

Amarapurkar¹,

Punamiya²,

Patel³

2008

WJG

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“…The use of TIPSs in patients with BC syndrome was initially described by Ochs et al 2 A TIPS decompresses the outflow obstruction and is less invasive than surgery; therefore, it provides an alternative to derivative surgery in patients with BC syndrome, especially those with high surgical risk, 2,4 and has the advantage over the surgical side-to-side portocaval shunt that bypasses the caval stenosis caused by a hypertrophied caudate lobe. 5 However, the optimal treatment of BC syndrome remains an open question.…”

Section: Discussionmentioning

confidence: 99%

Stenosis of the suprahepatic inferior vena cava as a complication of transjugular intrahepatic portosystemic shunt in Budd-Chiari patients

Turnés

García‐Pagán

González-Abraldes

et al. 2001

Liver Transplantation

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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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Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome

Cited by 132 publications

References 32 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

Stenosis of the suprahepatic inferior vena cava as a complication of transjugular intrahepatic portosystemic shunt in Budd-Chiari patients

Imaging and interventions in Budd-Chiari syndrome

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