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TIPS is a useful long‐term derivative therapy for patients with Budd‐Chiari syndrome uncontrolled by medical therapy
Author(s) -
Perelló Antonia,
GarcíaPagán Juan Carlos,
Gilabert Rosa,
Suárez Yanette,
Moitinho Eduardo,
Cervantes Francisco,
Reverter Juan Carlos,
Escorsell Angels,
Bosch Jaume,
Rodés Juan
Publication year - 2002
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2002.30274
Subject(s) - medicine , budd–chiari syndrome , transjugular intrahepatic portosystemic shunt , surgery , liver transplantation , portal hypertension , ascites , portacaval shunt , asymptomatic , angioplasty , portal vein thrombosis , cirrhosis , transplantation , portosystemic shunt , stenosis , thrombosis , radiology , inferior vena cava
Patients with Budd‐Chiari syndrome (BCS) may require treatment with portal decompressive surgery or liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) represents a new treatment alternative, but its long‐term effect on BCS outcome has not been evaluated. Twenty‐one patients with BCS consecutively admitted to our unit were evaluated. The mean follow‐up was 4 ± 3 years. Seven patients had nonprogressive forms and were successfully controlled with medical therapy; 1 case, with a short‐length hepatic vein stenosis was successfully treated by angioplasty. All 8 patients are alive and asymptomatic. The remaining 13 patients, had a TIPS because of clinical deterioration (in one of them, because early TIPS thrombosis a successful side‐to‐side portacaval shunt [SSPCS] was performed) followed by an improvement in clinical condition. However, a patient with fulminant liver failure before TIPS insertion, died 4 months later and another patient with cirrhosis at diagnosis had liver transplantation 2 years later. The remaining 11 patients are alive and free of ascites. In 3 of these patients TIPS is patent after 3, 6, and 12 months. The remaining 8 patients developed late TIPS dysfunction. In two of these cases, after angioplasty and restenting, TIPS is patent after a follow‐up of 9 and 80 months. In 5 other patients, recurring TIPS occlusion was not further corrected because no signs of portal hypertension were present. In conclusion, in patients with BCS uncontrolled with medical therapy, TIPS is a highly effective technique that is associated with long‐term survival.