Improvement in Esophageal Varices and Liver Histology Postoperatively in Budd-Chiari Syndrome

Kuniyoshi, Yukio; Koja, Kageharu; Akasaki, Mitsuru; Miyagi, Kazufumi; Shimoji, Mituyoshi; Kudaka, Manabu; Uezu, Tooru

doi:10.1016/s0003-4975(98)00293-8

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…3,4 The primary objective of our operation is to prevent further deterioration of liver function by reconstructing the occluded IVC and reopening the occluded hepatic veins. 1,2 Another objective is to restore the congested blood to the physiological normal circulation from the portal vein to the IVC, through the liver. Although the portal vein/liver sinusoid/IVC circulation is essentially a low-pressure system, portal hypertension develops with the progression of liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…We reconstructed the occluded inferior vena cave (IVC) with an autologous pericardial patch and simultaneously reopened as many occluded hepatic veins as possible. 1,2 The intrahepatic status of the hepatic veins was confirmed by intraoperative ultrasonography. The thickened caval wall, which occludes the ostia of the hepatic veins, was partially resected to reopen the hepatic veins.…”

Section: Methodsmentioning

confidence: 99%

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Improvement of Liver Function After Surgery for Budd-Chiari Syndrome

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Improvement of Liver Function After Surgery for Budd-Chiari Syndrome

et al. 2005

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“…19,106,[136][137][138][139][146][147][148]167,168,[180][181][182][183][184][185][186][187][188][189][190][191][192][193] Guidelines for treatment of stenosis and obstruction in BCS Obstruction or stenosis of the main trunk of the hepatic vein or the hepatic segment of the inferior vena cava should be treated by recanalization or dilatation with a catheter, stent placement, surgery to directly eliminate the obstruction and stenosis, or a shunt operation between the upper and lower sites of obstruction and stenosis of the vena cava. 131,[194][195][196][197][198][199][200][201][202][203][204][205][206] In acute cases with thrombus obstruction up to the peripheral part of the hepatic vein, the liver resection and peripheral hepatic vein-right atrium anastomosis may be an option. [207][208][209][210][211] In cases with liver failure, liver transplantation should b...…”

Section: Guidelines For Treatment Of Splenomegaly and Hypersplenismmentioning

confidence: 99%

“…Obstruction or stenosis of the main trunk of the hepatic vein or the hepatic segment of the inferior vena cava should be treated by recanalization or dilatation with a catheter, stent placement, surgery to directly eliminate the obstruction and stenosis, or a shunt operation between the upper and lower sites of obstruction and stenosis of the vena cava . In acute cases with thrombus obstruction up to the peripheral part of the hepatic vein, the liver resection and peripheral hepatic vein–right atrium anastomosis may be an option .…”

Section: Guidelines For Treatment Of Aberrant Portal Hemodynamicsmentioning

confidence: 99%

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Furuichi

Tanaka

Takikawa

et al. 2017

Hepatology Research

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Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.

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“…In selected patients, surgical reconstruction of the cava and hepatic venous ostia may effectively reduce centrilobular congestion and progression of fibrosis [54]. Transatrial membranotomy with finger fracture or excision is beneficial for patients with fenestrated membranes [3••,49,55,56].…”

Section: Surgerymentioning

confidence: 99%

Budd-Chiari syndrome

Faust

1999

Curr Treat Options Gastro

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Many options are available to diagnose and treat patients with the Budd-Chiari syndrome who present with either thrombotic or non-thrombotic occlusion of the major hepatic veins and or vena cava. The goal of therapy is to alleviate venous obstruction and to preserve hepatic function. Low-sodium diets, diuretics, and therapeutic paracentesis are generally ineffective, except for the rare patient who presents with volume overload and incomplete hepatic venous occlusion. Anticoagulants and thrombolytics may be appropriate for selected patients with acute thrombotic venous obstruction. Percutaneous transluminal angioplasty (PTA) of hepatic venous stenoses or caval webs with or without placement of intraluminal stents yield excellent short-term results, but additional studies are warranted to assess long-term efficacy. Transjugular intrahepatic portosystemic shunts (TIPS) may be effective for patients with subacute or chronic disease and ascites refractory to sodium restriction and diuretics. Intrahepatic stents may also serve as a bridge to transplantation for selected patients presenting with fulminant hepatic failure consequent to hepatic venous occlusion. Additional studies will be necessary to assess the role of TIPS in the armamentarium of therapies for patients with the Budd-Chiari syndrome. Decompressive shunts, reconstruction of the vena cava and hepatic venous ostia, transatrial membranotomy, and dorsocranial resection of the liver with hepatoatrial anastomosis are appropriate options for patients with acute or subacute disease who are not candidates for, or fail less invasive therapies. The majority of patients benefit with improvement in liver function tests, ascites, and liver histology; however, hepatic function may deteriorate in patients with marginal reserve. Liver transplantation is reserved for patients with Budd-Chiari syndrome who present with fulminant hepatic failure or end-stage liver disease with portal hypertensive complications. Transplantation is also appropriate for patients who deteriorate after failed attempts at surgical shunting.

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Improvement in Esophageal Varices and Liver Histology Postoperatively in Budd-Chiari Syndrome

Cited by 14 publications

References 13 publications

Improvement of Liver Function After Surgery for Budd-Chiari Syndrome

Improvement of Liver Function After Surgery for Budd-Chiari Syndrome

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Budd-Chiari syndrome

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