TIPS for acute and chronic Budd–Chiari syndrome: a single-centre experience

Mancuso, Andrea; Fung, Konrad; Mela, Maria; Tibballs, Jonathan; Watkinson, A.; Burroughs, Andrew K.; Patch, David

doi:10.1016/s0168-8278(03)00118-1

Cited by 131 publications

(79 citation statements)

References 19 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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“…TIPS is surely the mostly used treatment for BCS when medical therapy fails [3] . In early experiences, TIPS has proved effective as BCS treatment, also in the technically difficult case of extension of thrombosis to the por-tal vein tree [10,11] . Recently, a multi-centre study provides long-term data on TIPS treatment for 147 BCS with a 10 year survival of 69% [12] .…”

Section: Discussionmentioning

confidence: 99%

“…However, apart from liver transplantation, surgical approach is performed in a minority of patients [3] . This is probably the consequence of the absence of a well established surgical strategy for BCS, the huge difference in the outcome reported after surgery and the good response homogeneously reported after interventional approaches [4][5][6][7][8][9][10][11][12][13] . In fact, TIPS has recently become the standard treatment of BCS non responsive to medical therapy [3] .…”

Section: Case Reportmentioning

confidence: 99%

A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction

Mancuso

Martinelli²,

Carlis³

et al. 2013

WJH

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Transjugular intrahepatic portosystemic shunt (TIPS) is the standard treatment of Budd-Chiari syndrome (BCS) non responsive to medical therapy. However, patients with inferior vena cava (IVC) obstruction proximal to the atrium do not benefit from TIPS and a surgical approach is mandatory. We report the case of BCS due to intrapericardial IVC obstruction. We describe a novel surgical approach using a fresh caval homograft. An attempt to balloon dilatation of the IVC obstruction was complicated by right atrial disruption with tamponade and ventricular fibrillation. Lately, the patient successfully underwent a reconstruction of the cavoatrial continuity by the interposition of a fresh caval homograft, a novel surgical approach never described before for BCS. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement. IVC obstruction near to the atrium can be surgically approached with a new technique consisting in inferior vena cava resection and replacement with a caval homograft. Key words: Budd-Chiari syndrome; Inferior vena cava; Occlusion; Surgery; Liver transplantation Core tip: We describe a novel surgical approach using a fresh caval homograft for inferior vena cava (IVC) obstruction proximal to the atrium. An attempt to balloon dilatation of the IVC obstruction was complicated by right atrial disruption with tamponade and ventricular fibrillation. Lately, the patient successfully underwent a reconstruction of the cavo-atrial continuity by the interposition of a fresh caval homograft, a novel surgical approach never described before for Budd-Chiari syndrome. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement.

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“…TIPS has been shown to be effective as the treatment for BCS in early experiences [21][22][23] and can be successful also in the technically difficult case of extension of thrombosis to the portal vein tree [24,25] . Moreover, a multi-center experience provided long-term data on TIPS treatment for 147 BCS patients not responding to medical treatment or recanalization.…”

Section: Treatments For Budd-chiari Syndromementioning

confidence: 99%

Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: An Italian hepatologist’s perspective

Mancuso

2017

Journal of Translational Internal Medicine

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Budd-Chiari syndrome (BCS) management flow-chart is derived from experts' opinion and is not evidence-based. Guidelines suggest BCS management should follow a stepwise strategy: medical therapy as first-line treatment, revascularization or transjugular intrahepatic portosystemic shunt (TIPS) if no response to medical therapy, and liver transplant as rescue therapy. Recent evidence suggests that only medical therapy results in a bad long-term outcome. The biggest criticism of guidelines is the indication that BCS should receive further treatment only when hemodynamic consequences of portal hypertension become clinically evident. Recent data support that in BCS liver fibrosis could arise from chronic microvascular ischemia. A reasoning model of BCS physiopathology is that impaired hepatic vein outflow has hemodynamic consequences on portal hypertension development and causes hepatic fibrosis and liver failure through chronic ischemic damage. On this assumption is the concept that relieving liver congestion could ameliorate liver function and prevent development of BCS complications. Recently, early interventional treatment with TIPS for BCS has been reported to be effective. Early TIPS seems to be the best option for BCS management. Future multicenter controlled studies should compare the outcome of BCS treated with early interventional treatment compared with stepwise strategy.

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TIPS for acute and chronic Budd–Chiari syndrome: a single-centre experience

Cited by 131 publications

References 19 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

A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction

Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: An Italian hepatologist’s perspective

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