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Acute Budd–Chiari syndrome with liver failure: The experience of a policy of initial interventional radiological treatment using transjugular intrahepatic portosystemic shunt
Author(s) -
KAVANAGH PAUL M,
ROBERTS JAQUELINE,
GIBNEY ROBIN,
MALONE DERMOT,
HEGARTY JOHN,
MCCORMICK P AIDEN
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03427.x
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , budd–chiari syndrome , portal hypertension , radiological weapon , portosystemic shunt , radiology , shunt (medical) , liver failure , surgery , cirrhosis , gastroenterology , inferior vena cava
Background and Aims: The optimal management of acute Budd–Chiari syndrome (BCS) with liver failure is controversial. Options include anticoagulation, portal systemic shunting or liver transplantation. In recent years, transjugular intrahepatic portosystemic shunts (TIPS) have been tried in place of shunt surgery. We report our experience with a policy of initial interventional radiological treatment (TIPS) in this patient group. Methods: A consecutive, non‐selected series of five patients with acute BCS with liver failure presenting to our liver unit over a 36‐month period from October 2000 were treated with a policy of initial attempt at transjugular shunt. Results: Stents were successfully inserted in four patients. In one patient the hepatic vein remnant could not be cannulated. One of the four stented patients had a hepatic venous web. Rapid recurrent portal and hepatic vein thrombosis occurred in one patient despite anticoagulation and trans‐shunt thrombectomy. This patient and the patient with failed stenting underwent successful liver transplantation. One successfully stented patient died unexpectedly at home 2 weeks after TIPS insertion. Four of five patients are alive (80%) at a mean follow‐up time of 30 months. Conclusion: Initial TIPS, with liver transplantation for treatment failures, may be a reasonable, cost‐effective and surgery‐sparing treatment for acute Budd–Chiari presenting with liver failure.