Changes in Liver Congestion in Patients with Budd–Chiari Syndrome following Endovascular Interventions: Assessment with Transient Elastography

Mukund, Amar; Pargewar, Sudheer; Desai, Saloni N; Rajesh, S; Sarin, Shiv Kumar

doi:10.1016/j.jvir.2016.11.091

Cited by 44 publications

(43 citation statements)

References 10 publications

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“…LSM values were correlated with prestenotic hepatic vein pressure and decreased after endovascular treatment. 140,141 Although changes in pressure values did not correlate well with changes in LSM in one study using VCTE, 140 the absence of a postprocedural decrease or the occurrence of an increase in LSM was linked to treatment failure or disease recurrence in another study using 2D-SWE (SSI), 141 respectively. Finally, a recent study performing paired MRE-based LSM in 23 patients undergoing angioplasty found decreases in LSM that correlated well with changes in pressure gradient between the prestenotic hepatic vein and the inferior vena cava/right atrium.…”

Section: Potential Use In Sinusoidal Obstruction and Budd-chiari Syndmentioning

confidence: 96%

“…139 Moreover, small studies provide evidence on the use of elastography methods as noninvasive surrogates of portal hypertension in BCS (i.e., a postsinusoidal/posthepatic form of portal hypertension). Due to hepatic outflow obstruction, patients with BCS usually present with high liver 140,141 and spleen stiffness, 142 as assessed by different US elastography techniques. LSM values were correlated with prestenotic hepatic vein pressure and decreased after endovascular treatment.…”

Section: Potential Use In Sinusoidal Obstruction and Budd-chiari Syndmentioning

confidence: 99%

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Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

et al. 2020

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Noninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.

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Section: Potential Use In Sinusoidal Obstruction and Budd-chiari Syndmentioning

confidence: 96%

Section: Potential Use In Sinusoidal Obstruction and Budd-chiari Syndmentioning

confidence: 99%

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

et al. 2020

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“…Noninvasive tests (NITs), such as liver (LSM) and spleen (SSM) stiffness measurements, have been widely validated as accurate surrogates of PH [6] and its complications, such as high-risk esophageal varices [7, 8] or hepatic decompensation [9, 10], in patients with advanced chronic liver disease (ACLD). To our knowledge, only two studies [11, 12] have described LSM and its changes after endovascular treatment in BCS patients, suggesting that LSM reflects liver congestion rather than the fibrosis stage in these cases. On the other hand, SSM has not yet been described in this context.…”

Section: Introductionmentioning

confidence: 99%

Liver and Spleen Stiffness Measurements for Assessment of Portal Hypertension Severity in Patients with Budd Chiari Syndrome

Dajti

Ravaioli

Colecchia³

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Aims Budd-Chiari Syndrome (BCS) is a rare vascular disease of the liver caused by the obstruction of the hepatic venous outflow located from the small hepatic venules up to the entrance of the inferior vena cava (IVC) into the right atrium. Current prognostic indexes are suboptimal for an individual prognostic assessment and subsequent management of patients with BCS. Liver (LSM) and spleen (SSM) stiffness measurements are widely validated prognostic tools in hepatology, but the evidence in patients with BCS is limited. This paper describes LSM and SSM in patients with BCS and their correlation with clinical, biochemical, and ultrasound findings from the same patients. Methods We investigated a case series of seven patients with BCS diagnosis and available LSM and SSM evaluated by transient elastography (TE). Biochemical, imaging, and endoscopic findings nearest to the TE evaluation were recorded. Clinical outcomes and BCS evolution were described for each patient. When available, repeated TE assessments were also recorded. Results Patients with acute nonfulminant manifestation of BCS presented near-the-upper-limit values (75 kPa) of LSM and SSM, which often persist until the placement of a transjugular intrahepatic portosystemic shunt (TIPS). On the other hand, TE values were markedly lower in patients with compensated BCS. In some patients with repeated TE measurement years after TIPS placement, LSM had decreased to values of <10 kPa years. SSM changes in these patients were, however, less evident. Conclusions Extremely elevated values of LSM and SSM are suggestive of BCS. The evaluation of both LSM and SSM by TE could help clinicians in the initial evaluation, risk stratification, and therapy response monitoring of patients with BCS.

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“…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]. It is an indirect method to assess the outcome and therapeutic benefits of interventions aimed at decongesting the liver [8].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…LSM can also be used as a non-invasive tool to assess hepatic congestion before and after venous outflow restoration [8]. It is an indirect method to assess the outcome and therapeutic benefits of interventions aimed at decongesting the liver [8].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%