Anatomic Recanalization of Hepatic Vein and Inferior Vena Cava versus Direct Intrahepatic Portosystemic Shunt Creation in Budd-Chiari Syndrome: Overall Outcome and Midterm Transplant-Free Survival

Mukund, Amar; Mittal, Kartik; Mondal, Aniket; Sarin, Shiv Kumar

doi:10.1016/j.jvir.2018.01.781

Cited by 22 publications

(16 citation statements)

References 16 publications

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“…Liver stiffness measurements (LSM) using Fibroscan can be a promising tool to decide regarding the time of intervention. In asymptomatic patients, serial LSM may be used to assess the changes in liver congestion with medical management and in case of rising LSM, the patient may be offered endovascular treatments for liver decongestion [7]. LSM can also be used as a non-invasive tool to assess hepatic congestion before and after venous outflow restoration [8].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…1) [9]. Whenever possible, early recanalization of the obstructed hepatic venous outflow should be the first line of treatment in BCS, because these patients with recanalizable hepatic vein/inferior vena cava (IVC) generally have mild fibrosis with good post intervention outcome [7]. For the patients reported by Shukla et al, whether such an approach should be undertaken remains a debatable question, due to the adolescent age.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…Surgical management is considered if endovascular treatments are not feasible and includes membrane resection with/without IVC reconstruction, portosystemic/mesoatrial/portoatrial shunts, and liver transplant [4,5]. Liver transplant remains the preferred treatment for patients with fulminant BCS [4,5,7]. Most authors agree that not all patients with BCS should undergo liver transplant and that this therapeutic option should probably be used exclusively in patients with fulminant BCS or in patients with chronic cirrhosis [5,9].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…Several scores have been available and evaluated in BCS, such as, the Child-Pugh, MELD, Clichy PI, Rotterdam score, New Clichy PI and BCS-TIPS and may be used to predict the outcomes and prognosis of the disease [6]. The prognosis is better if disease is identified early and treatment is started [7]. Whether these approaches are feasible and provide long-term benefit in the pediatric and adolescent patients remains to be seen.…”

Section: Outcome and Prognosismentioning

confidence: 99%

See 3 more Smart Citations

Budd–Chiari syndrome: a focussed and collaborative approach

Mukund

Sarin

2018

Hepatol Int

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Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Section: Outcome and Prognosismentioning

confidence: 99%

See 2 more Smart Citations

Budd–Chiari syndrome: a focussed and collaborative approach

Mukund

Sarin

2018

Hepatol Int

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“…Alternatively, direct intrahepatic portosystemic shunt (DIPS) creation from the IVC to portal vein can also be considered. DIPS has been shown in literature to have equivalent five-year survival rates and clinical outcomes to HV recanalization with TIPS in patients with Budd-Chiari syndrome (Mukund et al 2018). Furthermore, DIPS may be preferred in such scenarios as it mitigates the risk of HV re-occlusion and the increased technical complexity for subsequent liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

et al. 2020

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Background: Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation: A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions: In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

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IR Management of Budd–Chiari Syndrome

Mukund

Biradar

2020

Basics of Hepatobiliary Interventions

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Anatomic Recanalization of Hepatic Vein and Inferior Vena Cava versus Direct Intrahepatic Portosystemic Shunt Creation in Budd-Chiari Syndrome: Overall Outcome and Midterm Transplant-Free Survival

Cited by 22 publications

References 16 publications

Budd–Chiari syndrome: a focussed and collaborative approach

Budd–Chiari syndrome: a focussed and collaborative approach

Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

IR Management of Budd–Chiari Syndrome

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