The Utility of TIPS in the Management of Budd-Chiari Syndrome

Molmenti, Ernesto P.; Segev, Dorry L.; Arepally, Aravind; Hong, Jenny J.; Thuluvath, Paul J.; Rai, Rudra; Klein, Andrew S.

doi:10.1097/01.sla.0000164180.77824.12

Cited by 57 publications

(26 citation statements)

References 21 publications

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“…TIPS is not only an important treatment for portal hypertension with esophageal variceal bleeding, but also an effective treatment for HV occlusive BCS. With improvements in the TIPS creation experience and technology as well as in the understanding of the anatomy of the post-liver IVC and liver parenchyma, extensive HV occlusive BCS has become the indications for TIPS [22]. In the classic TIPS procedure, the intrahepatic shunt is established between the right HV and intrahepatic branches of the PV, and the puncture point is always located in the right HV 2-3 cm away from the IVC.…”

Section: Portal Hemodynamicsmentioning

confidence: 99%

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

et al. 2016

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Section: Portal Hemodynamicsmentioning

confidence: 99%

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

et al. 2016

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“…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%

“…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%

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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“…The outcome depends on early and sustained restoration of the hepatic and portal venous outflow. [2,7] The initial management of our case began with phlebotomy, LMWH and the creation of a TIPS to alleviate the sinusoidal hepatocyte congestion. Unfortunately, despite the adequate anticoagulation treatment and the normalization of the liver It precipitated more extensive thrombotic and hemorrhagic events and caused a reocclusion of the stents.…”

Section: Discussionmentioning

confidence: 99%

Budd-Chiari syndrome and heparin-induced thrombocytopenia in polycythemia vera: Successful treatment with repeated TIPS and interferon alpha

Akoum

Mahfoud

Ghaoui³

et al. 2009

J Can Res Ther

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Polycythemia vera (PV) is a common cause of Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT). The postpartum period is a precipitating cofactor. An additional heparin-induced thrombocytopenia/thrombosis (HIT/T) leads to a life-threatening condition in which transjugular intrahepatic portosystemic shunting (TIPS) seems to be the only life-saving procedure. We describe the case of a subacute BCS and PVT in the late postpartum period. The diagnosis was established using CT scan, MRI, and Doppler ultrasonography of abdominal vessels and the laboratory findings were compatible with PV. After a successful creation of TIPS, a HIT/T worsened the hemorrhagic and thrombotic picture. TIPS procedure was successfully repeated and heparin was replaced with Fondaparinux and then vitamin K antagonist. The treatment with interferon alpha-2A, started after the normalization of liver functions, resulted in a complete remission within 6 months. The JAK2 V617F mutation clone remained undetectable after 2 years' follow-up.

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The Utility of TIPS in the Management of Budd-Chiari Syndrome

Cited by 57 publications

References 21 publications

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

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

Budd-Chiari syndrome and heparin-induced thrombocytopenia in polycythemia vera: Successful treatment with repeated TIPS and interferon alpha

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