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Martin EA, Solomon JA, Karnia JJ, Leach SB. Budd-Chiari-like syndrome in a dog secondary to a gunshot wound treated with balloon angioplasty and endovascular stent placement. J Vet Cardiol 2023; 48:46-53. [PMID: 37433242 DOI: 10.1016/j.jvc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
A 6-year-old female spayed Chihuahua mix presented with chronic recurrent ascites. Computed tomographic angiography revealed an isolated stenosis of the caudal vena cava secondary to a metallic foreign body, resulting in Budd-Chiari-like syndrome. Balloon angioplasty and endovascular stent placement successfully resolved the obstruction with long-term resolution of ascites.
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Affiliation(s)
- E A Martin
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 1600 East Rollins, Columbia, MO, 65211, USA
| | - J A Solomon
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - J J Karnia
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 1600 East Rollins, Columbia, MO, 65211, USA
| | - S B Leach
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 1600 East Rollins, Columbia, MO, 65211, USA.
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Evaluation of outcome from endovascular therapy for Budd-Chiari syndrome: a systematic review and meta-analysis. Sci Rep 2022; 12:16166. [PMID: 36171454 PMCID: PMC9519873 DOI: 10.1038/s41598-022-20399-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
This study was performed to evaluate the outcome of endovascular intervention therapy for Budd-Chiari syndrome (BCS) and compare recanalization, transjugular intrahepatic portosystemic shunt (TIPS)/direct intrahepatic portosystemic shunt (DIPS), and combined procedure treatment. For the meta-analysis, 71 studies were identified by searching four databases. The individual studies’ samples were used to calculate a confidence interval (CI 95%), and data were pooled using a fixed-effect model and random effect model. The pooled measure and an equal-weighted average rate were calculated in all participant studies. Heterogeneity between the studies was assessed with I2, and T2 tests, and publication bias was estimated using Egger’s regression test. A total of 4,407 BCS patients had undergone an endovascular intervention procedure. The pooled results were 98.9% (95% CI 97.8‒98.9%) for a technical success operation, and 96.9% (95% CI 94.9‒98.9%) for a clinical success operation. The re-intervention rate after the initial intervention procedure was 18.9% (95% CI 14.7‒22.9%), and the survival rates at 1 and 5 years after the initial intervention procedure were 98.9% (95% CI 96.8‒98.9%) and 94.9% (95% CI 92.9‒96.9%), respectively. Patients receiving recanalization treatment (98%) had a better prognosis than those with a combined procedure (95.6%) and TIPS/DIPS treatment (94.5%). The systematic review and meta-analysis further solidify the role of endovascular intervention treatment in BCS as safe and effective. It maintains high technical and clinical success and long-term survival rates. The recanalization treatment had a better prognosis and outcome than the combined procedures and TIPS/DIPS treatment.
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Patidar Y, Pal CK, Mukund A, Kumar G, Sarin SK. Retrospective comparative study of efficacy, safety and outcome of percutaneous intervention for Budd-Chiari syndrome patients with bilirubin less than 3 and 3-6 mg/dl. Br J Radiol 2021; 94:20201157. [PMID: 33595338 DOI: 10.1259/bjr.20201157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Comparing the efficacy, safety and outcome of percutaneous intrervention for Budd-Chiari Syndrome (BCS) patients with bilirubin less than 3 and 3-6 mg dl-1. METHODS AND MATERIALS 188 BCS patients having serum bilirubin ≤6 mg dl-1 and underwent percutaneous interventions were divided into two groups based on bilirubin level: 151 patients having bilirubin <3 mg dl-1 were included in Group 1; and 37 patients having bilirubin 3-6 mg dl-1 were included in Group 2. Both group were compare for technical success (successful recanalization of hepatic venous stenosis or creation of portocaval shunt with post-procedure gradient ≤5 mm of Hg), Safety (procedure-related mortality/morbidity or patient required transplantation) and outcome (resolution of clinical symptoms and survival). RESULTS Technical success was 94.7% in Group 1-89.1% in Group 2 with overall success rate was 93.6%. No significant differences observed between the two groups in regards to procedure related complication. Overall transplant-free survival at 1 and 5 years after intervention in both groups was 96.3 and 91.2% respectively. 1-year and 5-year survivals in Group 1 was 96.7%, and 93.1%, whereas Group 2 was 94.6 and 90.1% with no statically significantly difference between the two groups (p = 0.59). Percutaneous intervention results are good in patients having bilirubin up to 6 mg dl-1, i.e. mild to moderate liver dysfunctions. CONCLUSION Technical success, survival and outcome of percutaneous intervention in BCS patients having serum bilirubin 3-6 mg dl-1 was comparable to patients having bilirubin level <3 mg dl-1. ADVANCES IN KNOWLEDGE Percutaneous intervention treatment is suitable for treatment for symptomatic BCS patients having bilirubin up to 6 mg dl-1.
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Chandan Kumar Pal
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Weisse C, Scansen BA, Berent AC, Cober RE. Transatrial stenting for long-term management of cardiac tumor obstruction of the right atrium in 3 dogs. J Vet Intern Med 2020; 35:120-129. [PMID: 33338301 PMCID: PMC7848387 DOI: 10.1111/jvim.15999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background Venous obstruction in dogs caused by large intracardiac masses can result in severe morbidity with few safe treatments. Hypothesis/Objectives Retrospective study to report results after transatrial stent placement in dogs with naturally occurring cardiac masses causing venous obstruction. Animals Three client‐owned dogs diagnosed with large cardiac masses. Methods Retrospective study of patients that received transatrial stents extending from the caudal vena cava, across the right atrium, and into the cranial vena cava (CrVC). Procedures, complications, and outcomes were recorded based upon medical records, referring veterinarians, and client communications. Results Two dogs had similar clinical signs suggestive of congestive hepatopathy including marked ascites and lethargy. One dog had clinical signs of CrVC syndrome including head and neck swelling with pitting edema and pleural effusion. After stent placement, venous pressure gradients were decreased and repeat angiography confirmed that vascular patency was reestablished. Resolution of clinical signs was marked in all 3 dogs with only mild complications including tachyarrhythmias and hypertension in 1 dog during the perioperative period. Two dogs that required additional transatrial stent placement for reobstruction 6 and 14 months later improved after the second stent implantation. Survival times poststenting for the dogs were 3, 21, and 37 months, with cause of death related to the cardiac tumor in all dogs. Conclusions and Clinical Importance Endovascular transatrial stenting may provide a long‐term palliative treatment option for dogs with clinical signs attributable to tumor‐induced venous obstruction when more traditional treatments are declined or not indicated.
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Affiliation(s)
| | - Brian A Scansen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Rick E Cober
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
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Inchingolo R, Posa A, Mariappan M, Tibana TK, Nunes TF, Spiliopoulos S, Brountzos E. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: A comprehensive review. World J Gastroenterol 2020; 26:5060-5073. [PMID: 32982109 PMCID: PMC7495032 DOI: 10.3748/wjg.v26.i34.5060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/06/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Budd-Chiari syndrome (BCS) is a relatively rare clinical condition with a wide range of symptomatology, caused by the obstruction of the hepatic venous outflow. If left untreated, it has got an high mortality rate. Its management is based on a step-wise approach, depending on the clinical presentation, and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques, such as transjugular intrahepatic portosystemic shunt (TIPS). TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients, including those awaiting orthotopic liver transplantation. In this review the pathophysiology, diagnosis and treatment options of BCS are presented, with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS. Moreover, unresolved issues and future research will be discussed.
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Affiliation(s)
- Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional Hospital, Acquaviva delle Fonti 70021, Italy
- Department of Radiology, King´s College Hospital, London SE5 9RS, United Kingdom
| | - Alessandro Posa
- Department of Radiology, Gemelli Hospital, Roma 00135, Italy
| | - Martin Mariappan
- Interventional Radiology Department, Aberdeen Royal Infirmary Hospital, Aberdeen AB25 2ZN, United Kingdom
| | - Tiago Kojun Tibana
- Interventional Radiology Department, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil
| | - Thiago Franchi Nunes
- Interventional Radiology Department, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Chaidari Athens GR 12461, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Chaidari Athens GR 12461, Greece
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Jiménez Jiménez C, Randial Tagliapetra L, Silva I, Alférez F. Tratamiento endovascular del síndrome de Budd-Chiari, a propósito de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El síndrome de Budd-Chiari consiste en la oclusión de la circulación de salida venosa del hígado, desde las sinusoides hepáticas hasta la unión de la vena cava inferior con la aurícula derecha. Esta entidad es muy rara. Las causas son primarias, obstrucción congénita de la vena cava o trombosis espontánea, o secundarias, compresión extrínseca. Si no se trata la obstrucción esta enfermedad, lleva a cirrosis hepática.
Se presenta un caso del síndrome de Budd-Chiari de causa primaria por obstrucción membranosa, tratado por vía endovascular de manera exitosa y con resolución de todos los síntomas. Es el primer reporte en Colombia de este tipo de tratamiento.
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Sonavane AD, Amarapurkar DN, Rathod KR, Punamiya SJ. Long Term Survival of Patients Undergoing TIPS in Budd-Chiari Syndrome. J Clin Exp Hepatol 2019; 9:56-61. [PMID: 30765940 PMCID: PMC6363956 DOI: 10.1016/j.jceh.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has been significant improvement in understanding the etiology and management of Budd-Chiari Syndrome (BCS). Patients with chronic or acute-on-chronic BCS need radiological interventions in the form of angioplasty, hepatic vein/inferior vena cava stenting or Transjugular Intrahepatic Portosystemic Shunt (TIPS). Data regarding the long term follow up of patients undergoing TIPS is limited. We thus prospectively followed-up BCS patients who underwent TIPS at our center. METHODS This study included 42 patients with BCS who underwent TIPS with a covered stent between 2004 and 2014. We analyzed the etiology, symptoms, severity, laboratory parameters and imaging pre and post TIPS. All patients underwent surveillance for hepatocellular carcinoma. RESULTS Patients demographics included 26 males and 16 females with a mean age of 40.5 years (19-68 years). The mean Model for End-Stage Liver Disease score of the entire cohort was 15.38 (range: 9-25). Thirty-four patients were grouped into Rotterdam Class 2 and remaining into Class 3. There was significant improvement in ascites, gastrointestinal bleed, renal function and transaminase levels post TIPS. There were 11 deaths over the follow-up period - 4 within one month, 2 within six months and the rest after 3 years following TIPS. Median duration from clinical presentation to TIPS was 2.1 weeks and median survival till follow-up was 45.5 months (0-130 months). 33/42 patients underwent TIPS prior to 2013, and their median survival till follow-up was 55 months. Six out of eleven deaths that occurred within six months post-TIPS were before 2006; when the technique of TIPS creation was evolving. The cumulative 1 year, 5 years and 10 years OLT-free survival was 86%, 81% and 76%, respectively. Two patients underwent a liver transplant at 4 and 7 years after TIPS. CONCLUSION Our results validate the role of TIPS in the management of patients with BCS. With the accessibility of TIPS, the requirement for liver transplantation has become rare.
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Key Words
- AT III, Antithrombin III
- BCS, Budd-Chiari Syndrome
- Budd Chiari syndrome
- CT, Computerized Tomography
- CTP, Child-Turcotte-Pugh
- HV, Hepatic Vein
- INR, International Normalized Ratio
- IVC, Inferior Vena Cava
- JAK-2, Janus Kinase 2
- MELD, Model for End-Stage Liver Disease
- MRI, Magnetic Resonance Imaging
- MTHFR, Methylene Tetrahydrofolate Reductase
- OLT, Orthotopic Liver Transplantation
- SD, Standard Deviation
- TIPS, Transjugular Intrahepatic Portosystemic Shunt
- TIPS-BCS PI score, BCS-TIPS Prognostic Index score
- long term survival
- orthotopic liver transplantation free survival
- transjugular intrahepatic portosystemic shunt
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Affiliation(s)
- Amey D. Sonavane
- Post-graduate Resident, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India,Address for correspondence: Amey D. Sonavane, C-1804, Azziano, Rustomjee Urbania, Majiwada, Thane (West), Maharashtra 400601, India.
| | - Deepak N. Amarapurkar
- Consultant Gastroenterologist, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India
| | - Krantikumar R. Rathod
- Consultant, Department of Vascular and Interventional Radiology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India
| | - Sundeep J. Punamiya
- Consultant, Department of Vascular and Interventional Radiology, Tan Tock Seng Hospital, Singapore
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Bi Y, Chen H, Ding P, Ren J, Han X. Comparison of retrievable stents and permanent stents for Budd-Chiari syndrome due to obstructive inferior vena cava. J Gastroenterol Hepatol 2018; 33:2015-2021. [PMID: 29851172 DOI: 10.1111/jgh.14295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to compare long-term outcomes of retrievable stents (RSs) and permanent stents (PSs) for Budd-Chiari syndrome (BCS) due to long-segment obstructive inferior vena cava (IVC). METHODS Between July 2000 and August 2016, 42 patients with BCS due to long-segment obstructive IVC were treated with RSs, and 41 patients were treated with PSs. The RSs were removed eventually after thrombus disappeared. Patients were subsequently followed up by color Doppler sonography or computed tomography scanning. RESULTS All RS placements were successful, and 37 RSs were retrieved 8 to 29 days later. Forty-two stents were implanted in PS group. One failure retrieval of RSs occurred, and two failures of cannulations were found in PS group. Two deaths may be procedure related and died from acute pulmonary thromboembolism perioperatively. One patient developed acute cerebral infarction and recovered after treatment. In PS group, minor complications were found in three patients. The length of IVC lesion segment and length and thickness of IVC thrombus decreased significantly, and diameter of retrocaval IVC and diaphragm IVC increased significantly in both groups. During follow-up, three patients died from liver failure in RS group, and two patients died in PS group. RS group showed a significantly higher primary patency rate than PS group. Cumulative 1-, 3-, and 5-year secondary patency rates were 95.2%, 89.6%, and 89.6% in RS group and 100%, 96.6%, and 96.6% in PS group (P = 0.7109). CONCLUSIONS Retrievable stents are effective for BCS because of long-segment obstructive IVC, with a higher primary patency rate.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Bi Y, Chen H, Ding P, Zhou P, Han X, Ren J. Excellent long-term outcomes of endovascular treatment in budd-chiari syndrome with hepatic veins involvement: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e12944. [PMID: 30412110 PMCID: PMC6221688 DOI: 10.1097/md.0000000000012944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed. TIPSS Group showed significantly higher thrombotic/segmental obstruction and peripheral stenosis/obstruction compared with PTBA Group. The success rates were 93.9% and 100.0% in PTBA Group and TIPSS Group, respectively. The mean portal vein pressure decreased significantly after stenting. Except for 1 patient died from repeated hemorrhage, other sever complications had not been observed in both group. Twenty-six patients and 21 patients were clinically cured in PTBA Group and TIPSS Group, respectively. The primary patency rates were 89.7%, 79.3%, and 79.3% for short-term, mid-term and longterm in PTBA Group, which were significantly higher than TIPSS Group for long-term follow up. The second patency rates were 100.0%, 96.6% and 96.6% for short-term, mid-term and long-term in PTBA Group, which were similar to TIPSS Group (P = 1.0000). In conclusion, PTBA and TIPSS are safe and effective in the treatment of BCS with hepatic veins involvement, with an excellent long-term patency rate of hepatic vein and TIPSS shunt. TIPSS can be used to treat patients with all 3 hepatic veins lesion and failure PTBA.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Pengli Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
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Yagi T, Takagi K, Yoshida R, Umeda Y, Nobuoka D, Kuise T, Fujiwara T, Takaki A. New Left Lobe Transplantation Procedure with Caval Reconstruction Using an Inverted Composite Graft for Chronic Budd-Chiari Syndrome in Living-Donor Liver Transplantation-A Case Report. Transplant Proc 2018; 50:1192-1195. [PMID: 29731092 DOI: 10.1016/j.transproceed.2017.11.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/21/2017] [Indexed: 02/07/2023]
Abstract
When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC.
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Affiliation(s)
- T Yagi
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan.
| | - K Takagi
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - R Yoshida
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Y Umeda
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - D Nobuoka
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - T Kuise
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - T Fujiwara
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - A Takaki
- Departments of Gastroenterology, Transplant Surgery, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
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Sanchez-Ocaña R, Tejedor-Tejada J, Cimavilla-Roman M, de Benito-Sanz M, Asensio-Diaz E, Barrera-Rebollo A, Perez-Saborido B, Garcia-Pajares F, Almohalla-Alvarez C, Sanchez-Antolin G. Utility of Oral Anticoagulants as Prophylaxis of Recurrent Portal Thrombosis after Liver Transplantation. Transplant Proc 2018; 51:83-86. [PMID: 30655140 DOI: 10.1016/j.transproceed.2018.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/18/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Portal vein thrombosis (PVT) is a relatively common finding in patients undergoing liver transplantation. Although the recommendation to prevent its recurrence is anticoagulation for a duration of 3 to 6 months, this is controversial. AIM The aim of our study was to determine the efficacy of oral anticoagulants (OAC) as prophylaxis for recurrent PVT after liver transplantation. MATERIALS AND METHODS Our study included 215 liver transplant patients who underwent surgery in our center from January 2012 to August 2017. We selected all patients diagnosed with PVT either pre-transplantation (using Doppler echography or Angio-CT) or during transplant surgery. All patients with PVT were initially anticoagulated with low-molecular-weight heparin in the postoperative period; at discharge they received OAC for a duration of six months. Control Doppler ultrasound was performed at 3, 6, and 12 months post-transplantation. RESULTS PVT was identified in 37 out of 215 patients (17.2%). PVT was diagnosed with a pre-transplant vascular study in 17 out of 37 cases (45.9%). All patients were anticoagulated with OAC (warfarin) for at least 6 months. There were no cases of recurrent thrombosis and no complications associated with anticoagulant treatment throughout the follow-up period. CONCLUSIONS The prevalence of portal thrombosis in liver transplant patients in our study was fairly high, at 17.2%. PVT was identified in nearly 50% of patients using high-quality vascular studies prior to transplant surgery. Anticoagulation with OAC for 6 months was effective in preventing a recurrence of thrombosis and there were no associated complications.
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Affiliation(s)
- R Sanchez-Ocaña
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain.
| | - J Tejedor-Tejada
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - M Cimavilla-Roman
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - M de Benito-Sanz
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - E Asensio-Diaz
- Liver Transplant Unit, Surgery Department, Rio Hortega University Hospital, Valladolid, Spain
| | - A Barrera-Rebollo
- Liver Transplant Unit, Surgery Department, Rio Hortega University Hospital, Valladolid, Spain
| | - B Perez-Saborido
- Liver Transplant Unit, Surgery Department, Rio Hortega University Hospital, Valladolid, Spain
| | - F Garcia-Pajares
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - C Almohalla-Alvarez
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - G Sanchez-Antolin
- Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain
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12
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Long-term Outcome of Recoverable stents for Budd-Chiari syndrome Complicated with Inferior Vena Cava Thrombosis. Sci Rep 2018; 8:7393. [PMID: 29743653 PMCID: PMC5943331 DOI: 10.1038/s41598-018-25876-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/26/2018] [Indexed: 11/12/2022] Open
Abstract
This study aimed to present long-term results of a 12-year patient follow-up of recoverable stents for BCS complicated by inferior vena cava (IVC) thrombosis. Forty consecutive patients with BCS complicated by IVC thrombosis were treated with recoverable stents. The median duration of symptoms was 24 months. Recoverable stents was placed after predilation of the obstructed IVC, and then agitation thrombolysis or catheter-directed thrombolysis of IVC was performed. The recoverable stents was removed eventually after thrombus disappeared. Clinical patency was defined as absence or improvement of symptoms. Patients were subsequently followed-up by color Doppler ultrasound. Recoverable stents placement, balloon angioplasty and thrombolysis were technically successful in all patients. Stents were successfully removed in 92.1% of patients. A few serious related complications including one acute pulmonary thromboembolism, one stent migration, and one failure retrieval stents occurred. The median follow-up was 43.7 months. The long-term results were satisfactory except 2 patients who presented with a restenosis or re-obstruction and underwent additional therapy. There were 5 deaths owing to pulmonary embolism or underlying malignant disease 0.4–101.8 months after the procedures, including one procedure-related death. In conclusion, Recoverable stents treatment is safe and effective for BCS complicated by IVC thrombosis, with a good long-term outcome.
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Song RX, Cai SF, Ma S, Liu ZL, Gai YH, Zhang CQ, Wang GC. Magnetic Resonance Venography Findings of Obstructed Hepatic Veins and the Inferior Vena Cava in Patients with Budd-Chiari Syndrome. Korean J Radiol 2018; 19:381-388. [PMID: 29713215 PMCID: PMC5904464 DOI: 10.3348/kjr.2018.19.3.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/02/2017] [Indexed: 12/29/2022] Open
Abstract
Objective This study aimed to illustrate the magnetic resonance venography (MRV) manifestations of obstructed hepatic veins (HVs), the inferior vena cava (IVC), and accessory hepatic veins (AHVs) in patients with Budd-Chiari syndrome (BCS) and to evaluate the visualization capacity of MRV in the diagnosis of BCS. Materials and Methods Fifty-two patients with chronic BCS were included in this study. All patients were examined via MRV performed with a 3T system following injections of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) or Gd-ethoxibenzyl-DTPA. HV and IVC lesions were classified, and their characteristics were described. HV cord-like occlusions detected via MRV were compared using ultrasonography (US). Digital subtraction angiography (DSA) was performed as a contrast in the MRV detection of IVC lesions. The HVs draining collaterals, mainly AHVs, were carefully observed. HV lesions were classified as segmental stenosis, segmental occlusion, membranous stenosis, membranous occlusion, cord-like occlusion, or non-visualized. Except for patent IVCs, IVC lesions were classified as segmental occlusion, segmental stenosis, membranous occlusion, membranous stenosis, and hepatomegaly-induced stenosis. Results All patients (52/52, 100%) showed HV lesions of different degrees. MRV was inferior to US in detecting cord-like occlusions (6 vs. 19, χ2 = 11.077, p < 0.001). Dilated AHVs, including 50 (50/52, 96.2%) caudate lobe veins and 37 (37/52, 71.2%) inferior HV and AHV lesions, were well-detected. There were no significant differences in detecting segmental lesions and thrombosis between MRV and DSA (χ2 = 0.000, p1 = 1.000, p2 = 1.000). The capacity of MRV to detect membranous lesions was inferior to that of DSA (7 vs. 15, χ2 = 6.125, p = 0.013). Conclusion In patients with BCS, MRV can clearly display the lesions in HVs and the IVC, as well as in AHVs, and it has diagnostic and therapeutic value.
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Affiliation(s)
- Ru-Xin Song
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
| | - Shi-Feng Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
| | - Shuang Ma
- Department of Ultrasound, Fifth Hospital of Jinan, Ji'nan 250000, China
| | - Zhi-Ling Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
| | - Yong-Hao Gai
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
| | - Guang-Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China
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Das CJ, Soneja M, Tayal S, Chahal A, Srivastava S, Kumar A, Baruah U. Role of radiological imaging and interventions in management of Budd-Chiari syndrome. Clin Radiol 2018; 73:610-624. [PMID: 29549997 DOI: 10.1016/j.crad.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Budd-Chiari syndrome (BCS) is a clinical condition resulting from impaired hepatic venous drainage, in which there is obstruction to the hepatic venous outflow at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium leading to hepatic congestion. The diagnosis of BCS is based on imaging, which can be gathered from non-invasive investigations such as ultrasonography coupled with venous Doppler, triphasic computed tomography (CT) and magnetic resonance imaging (MRI). Apart from diagnosis, various interventional radiology procedures aid in the successful management of this syndrome. In this article, we present various imaging features of BCS along with various interventional procedures that are used to treat this diverse condition.
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Affiliation(s)
- C J Das
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India.
| | - M Soneja
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
| | - S Tayal
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
| | - A Chahal
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
| | - S Srivastava
- Department of Gastroenterology, GB Pant Hospital, New Delhi - 110002, India
| | - A Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi - 110002, India
| | - U Baruah
- Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
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Living donor liver transplantation for adult Budd Chiari syndrome - Resection without replacement of retrohepatic IVC: A case report. Int J Surg Case Rep 2017; 42:50-54. [PMID: 29216531 PMCID: PMC5724988 DOI: 10.1016/j.ijscr.2017.11.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 01/03/2023] Open
Abstract
Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction. Liver transplantation is a definitive treatment of BCS, indicated in failure of other treatment modalities or end stage liver diseases. The Budd-Chiari syndrome patients with IVC obstruction can receive liver transplantation with IVC removal and without IVC replacement. Living donor liver transplant with refined techniques can be performed safety with stable hemodynamics peri-and post-liver transplantation.
Introduction Suprahepatic caval resection and replacement of inferior vena cava (IVC) is standard procedure in deceased donor liver transplantation for patients with Budd-Chiari syndrome (BCS). However, replacement of IVC in living donor liver transplantation (LDLT) is difficult. We report a case of BCS successfully treated by LDLT without replacement of IVC. Presentation of case A 52-years-old female with a primary BCS due to IVC thrombosis. A vena cava (VC) stent placed after angioplasty without improvement of the hepatic, portal venous flow and liver functions, Transjugular intrahepatic portosystemic shunt was considered and the patient had a rapid deterioration and increased ascites. The patient was scheduled for living donor liver transplantation (LDLT). Her Child-Paugh and MELD scores were 11, 18, respectively at time of transplantation. Left lobe was obtained from her son. Preservation of the native suprarenal IVC was impossible due to massive fibrosis and thrombosed. The suprahepatic IVC was also fibrotic and unsuitable for anastomosis with hepatic vein. The retrohepatic IVC resected include suprahepatic IVC together with the liver. The supradiaphragmatic IVC was reached and encircled through opening the diaphragm around the IVC and a vascular clamp applied on the right atrium with subsequent anastomosis with hepatic vein of the graft. The hemodynamic stability of the patient was maintained throughout the operation without IVC replacement due to developed collateral vessels. Conclusion Patients with Budd-Chiari syndrome with obstructive IVC are successfully treated with living donor liver transplantation without replacement of IVC.
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Hatzidakis A, Galanakis N, Kehagias E, Samonakis D, Koulentaki M, Matrella E, Tsetis D. Ultrasound-guided direct intrahepatic portosystemic shunt in patients with Budd–Chiari syndrome: Short- and long-term results. Interv Med Appl Sci 2017. [DOI: 10.1556/1646.9.2017.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Adam Hatzidakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Dimitrios Samonakis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece
| | - Mairi Koulentaki
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece
| | - Erminia Matrella
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
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Rathod K, Deshmukh H, Shukla A, Popat B, Pandey A, Gupte A, Gupta DK, Bhatia SJ. Endovascular treatment of Budd-Chiari syndrome: Single center experience. J Gastroenterol Hepatol 2017; 32:237-243. [PMID: 27218672 DOI: 10.1111/jgh.13456] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Percutaneous radiologic interventions are increasingly being used in management of Budd-Chiari syndrome (BCS). Minimal invasive approach has resulted in excellent long-term outcomes. We evaluated the treatment efficacy and safety of radiological intervention in patients with BCS. METHODS Between January 2008 and June 2014, 190 patients with BCS underwent endovascular procedures (hepatic vein, collateral vein or inferior vena cava [IVC] plasty with or without stenting, or transjugular intrahepatic portosystemic shunting [TIPSS]). Clinical features, biochemical profile, and stent patency were monitored pre-procedure and post-procedure, and for a median duration of 42 (12-88) months. RESULTS Of 190 patients (mean [SD] age = 26.9 [11.5] years; 102 men), imaging revealed hepatic vein obstruction in 147 patients, IVC obstruction in 40 patients, and concomitant hepatic vein and IVC obstruction in three patients. At presentation, the radiological interventions included hepatic vein plasty/stenting in 38 patients, collateral vein stenting in three patients, IVC plasty/stenting in 40 patients, both IVC and hepatic vein stenting in three patients, and TIPSS in 106 patients. Response was seen in 153 patients (80.5%). Repeat interventions were required in 19 patients (10.0%). Complications were noted in nine patients (4.7%). CONCLUSION Our study demonstrates that venous recanalization and TIPSS for BCS are safe and efficacious.
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Affiliation(s)
- Krantikumar Rathod
- Department of Radiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Hemant Deshmukh
- Department of Radiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Akash Shukla
- Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Bhavesh Popat
- Department of Radiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ankur Pandey
- Department of Radiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Amit Gupte
- Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Deepak Kumar Gupta
- Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Shobna J Bhatia
- Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
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Outcome of the Z-expandable metallic stent for Budd-Chiari syndrome and segmental obstruction of the inferior vena cava. Eur J Gastroenterol Hepatol 2016; 28:972-9. [PMID: 27172449 DOI: 10.1097/meg.0000000000000640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Treatment of segmental obstruction of the inferior vena cava (SOIVC) with Z-expandable metallic stents (Z-EMS) is controversial and data on long-term follow-up are lacking. We aimed to evaluate the long-term outcomes of the use of a Z-EMS for Budd-Chiari syndrome (BCS) patients with SOIVC. MATERIALS AND METHODS Between August 2004 and December 2014, 37 consecutive BCS patients with SOIVC were referred for Z-EMS treatment and subsequently underwent follow-up in our department. Data were collected retrospectively and follow-up observations were made 1, 2, 2-5, and 5-10 years postoperatively. RESULTS Percutaneous transluminal balloon angioplasty and Z-EMS placement were technically successful in all patients. Major procedure-related complications occurred in four of 37 patients (10.81%). Follow-up for 61.89±41.45 months in 37 patients indicated portal hypertension in one patient 4 months after stent placement and symptoms were resolved by transjugular intrahepatic portosystemic stent shunting. Hepatocellular carcinoma was observed in four patients and five patients died during follow-up. Reocclusion of the inferior vena cava occurred in four patients (10.81%, 4/41) and all reocclusions were managed by percutaneous transluminal balloon angioplasty. Cumulative 1-, 2-, 2-5-, and 5-10-year primary patency rates were 94.60% (35/37), 93.33% (28/30), 88.89% (24/27), and 85.0% (17/20), respectively. Cumulative 1-, 2-, 2-5-, and 5-10-year secondary patency rates were 100% at all time-points. CONCLUSION These data suggest that Z-EMS implantation is an efficacious, safe, and curative approach for BCS with SOIVC because satisfactory long-term outcomes were achieved. Long-term follow-up is required to ascertain stent patency and hepatocellular carcinoma occurrence.
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Townsend SA, Karkhanis S, Tripathi D, Mueisan P, Zia Z, Elsharkawy AM. Rescue from liver transplantation: TIPSS and thrombectomy successfully treat a case of acute Budd-Chiari syndrome complicated by portal vein thrombosis. BJR Case Rep 2016; 3:20160059. [PMID: 30363345 PMCID: PMC6159308 DOI: 10.1259/bjrcr.20160059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/07/2016] [Indexed: 11/06/2022] Open
Abstract
We report the rare case of a female who presented with fulminant liver failure secondary to acute Budd-Chiari syndrome and complete portal vein thrombosis. She met the criterion for liver transplant and was transferred to our care for assessment and further management. Transplant was deemed a too-high risk and so rescue therapy was undertaken using mechanical thrombectomy and transjugular intrahepatic portosystemic shunt insertion to decompress the portal system. The patient made a full recovery. This is a rare case report of a patient meeting liver transplant criteria secondary to acute Budd-Chiari syndrome and complete portal vein thrombosis, which was managed successfully entirely by radiological means; this technique could be used to avoid or act as a bridge to liver transplantation in the future.
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Affiliation(s)
| | - Salil Karkhanis
- Radiology Department, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Paolo Mueisan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Zergham Zia
- Radiology Department, Queen Elizabeth Hospital, Birmingham, UK
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Faraoun SA, Boudjella MEA, Debzi N, Benidir N, Afredj N, Guerrache Y, Bentabak K, Soyer P, Bendib SE. Budd-Chiari syndrome: an update on imaging features. Clin Imaging 2016; 40:637-46. [PMID: 27317208 DOI: 10.1016/j.clinimag.2016.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 12/15/2022]
Abstract
Budd-Chiari syndrome (BCS) is a rare cause of portal hypertension and liver failure. This condition is characterized by an impaired hepatic venous drainage. The diagnosis of BCS is based on imaging, which helps initiate treatment. Imaging findings can be categorized into direct and indirect signs. Direct signs are the hallmarks of BCS and consist of visualization of obstructive lesions of the hepatic veins or the upper portion of the inferior vena cava. Indirect signs, which are secondary to venous obstruction, correspond to intra- and extrahepatic collateral circulation, perfusion abnormalities, dysmorphy and signs of portal hypertension.
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Affiliation(s)
- Sid Ahmed Faraoun
- Department of Radiology, Pierre and Marie Curie Center, Place du 1er Mai, 16016, Algiers, Algeria.
| | | | - Nabil Debzi
- Department of Hepatology, CHU Mustapha, Place du 1er Mai, 16016, Algiers, Algeria.
| | | | - Nawel Afredj
- Department of Hepatology, CHU Mustapha, Place du 1er Mai, 16016, Algiers, Algeria.
| | - Youcef Guerrache
- Department of Radiology, Pierre and Marie Curie Center, Place du 1er Mai, 16016, Algiers, Algeria.
| | - Kamel Bentabak
- Department of Durgery, Centre Pierre et Marie Curie, Place du 1er Mai, 16016, Algiers, Algeria.
| | - Philippe Soyer
- Université Sorbonne Paris Cité, Diderot Paris 7, 10 Avenue de Verdun, 75010, Paris, France.
| | - Salah Eddine Bendib
- Department of Radiology & Université Benyoucef Benkhedda d'Alger, Pierre and Marie Curie Center, Place du 1er Mai, 16016, Algiers, Algeria.
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Ding PX, Zhang SJ, Li Z, Fu MT, Hua ZH, Zhang WG. Long-term safety and outcome of percutaneous transhepatic venous balloon angioplasty for Budd-Chiari syndrome. J Gastroenterol Hepatol 2016; 31:222-8. [PMID: 26102208 DOI: 10.1111/jgh.13025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/21/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The restenosis following percutaneous transluminal balloon angioplasty (PTBA) is high for Budd-Chiari syndrome (BCS) patients with hepatic venous obstruction (HVO). We aim to evaluate the safety and long-term outcome of PTBA with a large balloon catheter in a large series of patients with HVO. METHODS Between January 2005 and December 2013, 93 consecutive BCS patients with HVO were referred for PTBA and subsequently underwent color Doppler ultrasonography or angiography follow-up. Data were retrospectively collected, and follow-up observations were performed at 1-, 2-, 2- to 5-, and 5- to 8-years postoperatively. RESULTS Percutaneous transluminal balloon angioplasty was technically successful in all patients. Ninety-one patients (97.85%) were treated with PTBA and two with PTBA and stent. Major procedure-related complications occurred in six of the 93 patients (6.45%). The cumulative 1-, 2-, 2- to 5-, and 5- to 8-year primary patency rates were 97.5%, 92.9%, 90%, and 86.5%, respectively. Cumulative 1-, 2-, 2- to 5-, and 5- to 8-year secondary patency rates were 100%, 100%, 98.6%, and 97.3%, respectively. Mean and median primary patency rates were 51.50 ± 3.01 months and 55.0 ± 3.63 months, respectively. Cumulative 1-, 2-, 2- to 5-, and 5- to 8-year survival rates were 98.75%, 98.6%, 100%, and 100%, respectively. Mean and median survival times were 53.10 ± 3.04 months and 55.0 ± 3.64 months, respectively. CONCLUSION Percutaneous transluminal balloon angioplasty with a large balloon is a safe and effective treatment that could provide excellent rates of long-term patency and survival for the majority of Chinese patients with BCS and HVO.
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Affiliation(s)
- Peng-Xu Ding
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shui-Jun Zhang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen Li
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ming-Ti Fu
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhao-Hui Hua
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wen-Guang Zhang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Ismail A, Bowles C, Dubrey S, Wallis A. Budd-Chiari syndrome: a rare complication of central venous line placement. Br J Hosp Med (Lond) 2015; 76:304-5. [PMID: 25959945 DOI: 10.12968/hmed.2015.76.5.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alaa Ismail
- Radiology Specialist Registrar in the Department of Radiology, Queen Alexandra Hospital, Portsmouth
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Massie A, Phillips H, Solomon J. Resolution of Budd‐Chiari syndrome secondary to needle foreign body migration in a dog: treatment with surgery and intravascular stenting. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2014-000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anna Massie
- North Houston Veterinary SpecialistsSpringTexasUSA
| | - Heidi Phillips
- Veterinary Clinical MedicineUniversity of IllinoisUrbanaIllinoisUSA
| | - Jeffrey Solomon
- Department of New Product DevelopmentInfiniti Medical LLCMenlo ParkCaliforniaUSA
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Abstract
OBJECTIVE Budd-Chiari syndrome (BCS) is an uncommon condition characterized by obstruction of the hepatic venous outflow tract. Presentation may vary from a completely asymptomatic condition to fulminant liver failure. BCS is an example of postsinusoidal portal hypertension. The management can be divided into three main categories: medical, surgical, and endovascular. The purpose of this article is to present an overall perspective of the problem, diagnosis, and management. CONCLUSION BCS requires accurate, prompt diagnosis and aggressive therapy. Treatment will vary depending on the clinical presentation, cause, and anatomic location of the problem. Patients with BCS are probably best treated in tertiary care centers where liver transplantation is available.
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Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol 2012; 57:203-12. [PMID: 22446690 DOI: 10.1016/j.jhep.2011.12.034] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/08/2011] [Accepted: 12/22/2011] [Indexed: 12/13/2022]
Abstract
Portal vein thrombosis is not uncommon in candidates for transplantation. Partial thrombosis is more common than complete thrombosis. Despite careful screening at evaluation, a number of patients are still found with previously unrecognized thrombosis per-operatively. The objective is to recanalize the portal vein or, if recanalization is not achievable, to prevent the extension of the thrombus so that a splanchnic vein can be used as the inflow vessel to restore physiological blood flow to the allograft. Anticoagulation during waiting time and transjugular intrahepatic portosystemic shunt (TIPS) are two options to achieve these goals. TIPS may achieve recanalization in patients with complete portal vein thrombosis. However, a marked impairment in liver function, which is a characteristic feature of most candidates for transplantation, may be a contraindication for TIPS. Importantly, the MELD score is artificially increased by the administration of vitamin K antagonists due to prolonged INR. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (renoportal anastomosis or cavoportal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks. Multivisceral transplantation including the liver and small bowel needs to be evaluated. In the absence of prothrombotic states that may persist after transplantation, there is no evidence that pre-transplant portal vein thrombosis justifies long term anticoagulation post-transplantation, provided portal flow has been restored through conventional end-to-end portal anastomosis.
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Affiliation(s)
- Claire Francoz
- Hepatology and Liver Intensive Care, Hopital Beaujon, Clichy, INSERM U773 CRB3, University of Paris VII Denis Diderot, Paris, France
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Ogura Y, Kanazawa H, Yoshizawa A, Nitta T, Ikeda T, Uemoto S. Supradiaphragmatic approach for Budd-Chiari syndrome with transjugular intrahepatic portosystemic shunt stent in combination with inferior vena cava reconstruction during living donor liver transplantation: a case report. Transplant Proc 2011; 43:2093-6. [PMID: 21693334 DOI: 10.1016/j.transproceed.2011.03.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/15/2011] [Indexed: 02/08/2023]
Abstract
Treatment of Budd-Chiari syndrome consists of medical management, surgical shunt, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. Liver transplantation is indicated only when other treatments have failed. A 36-year-old Japanese man underwent living-donor liver transplantation after radiologic intervention procedures. Because of the position of the TIPS stent and the damaged vascular lesion of Budd-Chiari syndrome, a supradiaphragmatic approach was employed to achieve a safe total hepatectomy. Moreover, after resection of damaged portion of the inferior vena cava (IVC), an artificial vascular graft was utilized to fill the IVC gap. The postoperative course was uneventful; no serious complications were experienced within 2 years after liver transplantation. This supradiaphragmatic IVC approach and IVC reconstruction technique emphasized the option of surgical techniques to decrease the operative risk during liver transplantation for Budd-Chiari syndrome.
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Affiliation(s)
- Y Ogura
- Department of Surgery, HPB and Transplantation Surgery, Kyoto University Hospital, Kyoto City, Japan.
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Long-term follow-up of liver transplantation for Budd-Chiari syndrome with antithrombotic therapy based on the etiology. Transplantation 2011; 92:341-5. [PMID: 21659946 DOI: 10.1097/tp.0b013e3182247b05] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because myeloproliferative disorders (MPDs) are a frequent cause of Budd-Chiari syndrome (BCS), treatment directed toward altering platelet production and function may be more rational and effective than anticoagulation after liver transplantation. METHODS We reviewed data on 25 patients who received liver transplantation for BCS at our institution from 1987 to 2007. Posttransplant antithrombotic treatment was based on the cause of BCS: 17 patients with MPDs received hydroxyurea/aspirin; 5 received warfarin; and 3 (2 whose hypercoagulable disorder was corrected and 1 with sarcoidosis) received no therapy. RESULTS Both graft survival (88% at 5 years) and patient survival (92% at 5 years) were superior in the BCS group compared with the 2609 patients who received liver transplants for other indications. Vascular complications included three instances of hepatic artery stenosis (NS compared with non-BCS liver recipients), one of portal vein thrombosis (nonsignificant [NS]), and one of portal vein stenosis (NS). All 25 patients underwent multiple liver biopsies with no bleeding complications. CONCLUSIONS Using hydroxyurea and aspirin to treat patients with BCS caused by an MPD seems to be safe and effective and avoids the risks of anticoagulation with warfarin.
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Chen H, Cheng Y, Ning S, Chen Y. Budd--Chiari syndrome caused by multiple membranous obstruction of the inferior vena cava in a young man. Ann Vasc Surg 2011; 25:1139.e5-7. [PMID: 21835582 DOI: 10.1016/j.avsg.2011.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 06/01/2011] [Accepted: 06/14/2011] [Indexed: 11/18/2022]
Abstract
Membranous obstruction of the inferior vena cava is a frequent cause of Budd--Chiari syndrome in Eastern countries. The study reports the case of a young male patient with Budd--Chiari syndrome caused by extremely rare multiple membranous obstruction of inferior vena cava. A percutaneous transluminal angioplasty with stent placement was performed successfully, accompanied with satisfactory resolution of clinical symptoms and signs. The graft was reported to be patent 2 years postoperatively.
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Affiliation(s)
- Hongqiang Chen
- Department of Hepato-Biliary, Qilu Hospital, Shandong University, Ji'nan, China
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Dang XW, Xu PQ, Ma XX, Xu DQ, Zhu YJ, Zhang YS. Surgical treatment of Budd-Chiari syndrome: analysis of 221 cases. Hepatobiliary Pancreat Dis Int 2011; 10:435-8. [PMID: 21813395 DOI: 10.1016/s1499-3872(11)60074-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Budd-Chiari syndrome (B-CS) refers to post-hepatic portal hypertension and/or inferior vena cava hypertension caused by obstruction of blood flow at the portal cardinal hepatic vein. The treatments of B-CS include operations on pathological membrane lesions, shunting and combined operations. Studies have shown that China, Japan, India and South Africa have a high incidence of B-CS. In China, the Yellow River Basin in Henan, Shandong, Jiangsu and Anhui Provinces also have a high incidence, around 10 per 100 000. METHODS The clinical data of 221 B-CS patients were analyzed retrospectively. We focused on pathological types, surgical methods, effectiveness and complications of treatment, and follow-up. RESULTS Based on imaging findings such as color ultrasonography, angiography or magnetic resonance angiography, the 221 patients were divided into 3 types (five subtypes): type Ia (72 patients), type Ib (20), type II (72), type IIIa (33), and type IIIb (24). Surgical procedures included balloon membranotomy with or without stent (65 patients), improved splenopneumopexy (18), radical resection of membrane and thrombus (17), inferior vena cava bypass [29, with cavocaval transflow (13) and cavoatrial transflow (16)], mesocaval shunt (41), splenocaval shunt (25), splenoatrial shunt (12), splenojugular shunt (6), and combined methods (8). The complication rate was 9.05% (20/221) and the perioperative death rate was 2.26% (5/221). All of the patients were followed up from 6 months to 5 years. The success rate was 84.6% (187/221), and the recurrence rate was 8.9% (9/101) and 13.5% (13/96) after 1- and 5-year follow-up, respectively. CONCLUSION The rational choice of surgical treatment based on B-CS pathological typing may increase the success rate and decrease the recurrence.
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Affiliation(s)
- Xiao-Wei Dang
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
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31
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Chen H, Zhang F, Ye Y, Cheng Y, Chen Y. Long-Term Follow-Up Study and Comparison of Meso-Atrial Shunts and Meso-Cavo-Atrial Shunts for Treatment of Combined Budd-Chiari Syndrome. J Surg Res 2011; 168:162-6. [DOI: 10.1016/j.jss.2009.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 07/14/2009] [Accepted: 07/15/2009] [Indexed: 02/07/2023]
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Anticoagulation With Warfarin for Budd–Chiari Syndrome with Chronic Inferior Vena Cava Thrombosis: An Initial Clinical Experience. Ann Vasc Surg 2011; 25:359-65. [DOI: 10.1016/j.avsg.2010.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 06/07/2010] [Accepted: 07/19/2010] [Indexed: 11/17/2022]
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Loo J, Selby R, Genyk Y, Sher L, Alexopoulos S, Stapfer M. Removal of a Large Hepatic Neuroendocrine Tumor Causing Budd-Chiari Syndrome using a Median Sternotomy Approach in Conjunction with a Midline Laparotomy Incision. Am Surg 2011. [DOI: 10.1177/000313481107700203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jerry Loo
- Keck School of Medicine University of Southern California Los Angeles, California
| | - Rick Selby
- Hepatobiliary and Pancreas Surgery Department of Surgery Keck School of Medicine University of Southern California Los Angeles, California
| | - Yuri Genyk
- Department of Surgery Keck School of Medicine University of Southern California Los Angeles, California
| | - Linda Sher
- Department of Surgery Keck School of Medicine University of Southern California Los Angeles, California
| | - Sophoclis Alexopoulos
- Department of Surgery Keck School of Medicine University of Southern California Los Angeles, California
| | - Maria Stapfer
- Department of Surgery Keck School of Medicine University of Southern California Los Angeles, California
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Varma V, Mehta N, Kumaran V, Nundy S. Indications and contraindications for liver transplantation. Int J Hepatol 2011; 2011:121862. [PMID: 22007310 PMCID: PMC3189562 DOI: 10.4061/2011/121862] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/10/2011] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic liver disease and certain patients with acute liver failure require liver transplantation as a life-saving measure. Liver transplantation has undergone major improvements, with better selection of candidates for transplantation and allocation of scarce deceased donor organs (according to more objective criteria). Living donor liver transplantation came into existence to overcome the shortage of donor organs especially in countries where there was virtually no deceased donor programme. Advances in the technical aspects of the procedure, the intraoperative and postoperative care of both recipients and donors, coupled with the introduction of better immunosuppression protocols, have led to graft and patient survivals of over 90% in most high volume centres. Controversial areas like transplantation in alcoholic liver disease without abstinence, acute alcoholic hepatitis, and retransplantation for recurrent hepatitis C virus infection require continuing discussion.
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Affiliation(s)
- Vibha Varma
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Vinay Kumaran
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital Room No. 2221, SSR Block, Rajinder Nagar, New Delhi 110060, India,*Samiran Nundy:
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35
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Shin W, Kim Y, Hwang G. Serial Monitoring of B-Type Natriuretic Peptide in Management of Heart Failure After Liver Transplantation in a Patient With Budd-Chiari Syndrome: Case Report. Transplant Proc 2010; 42:2791-3. [DOI: 10.1016/j.transproceed.2010.04.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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Choi GS, Park JB, Jung GO, Chun JM, Kim JM, Moon JI, Kwon CHD, Kim SJ, Joh JW, Lee SK. Living donor liver transplantation in Budd-Chiari syndrome: a single-center experience. Transplant Proc 2010; 42:839-42. [PMID: 20430186 DOI: 10.1016/j.transproceed.2010.02.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Budd-Chiari syndrome (BCS), which is characterized by hepatic venous outflow obstruction due to occlusion of the major hepatic vein and/or the inferior vena cava (IVC), is rare. Traditionally, a caval resection is advocated for these patients; however, such a maneuver renders living donor liver transplantation (LDLT) impossible. We encountered BCS in 4/377 LDLT patients during a 5-year period (January 2003 to December 2007). This report examine the various surgical modifications in these 4 patients, who underwent to LDLT for BCS. Resection of right hepatic vein (RHV) with an adjacent fibrotic part of the IVC with direct anastomosis of the graft RHV to the IVC was performed in 2 patients. One patient underwent retrohepatic IVC excision and reconstruction with a cryopreserved autologous IVC graft. The fourth patient, with a preexisting mesoatrial shunt for BCS, underwent conversion of this to a RHV atrial shunt. Graft and patient survivals were 100%. There were few complications in either donors or recipients. LDLT for BCS can be performed safely with adequate venous drainage techniques and with anticoagulant therapy and good follow-up for early diagnosis and treatment of recurrence leading to excellent long-term results.
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Affiliation(s)
- G S Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Warfarin anticoagulation before angioplasty relieves thrombus burden in Budd-Chiari syndrome caused by inferior vena cava anatomic obstruction. J Vasc Surg 2010; 52:1242-5. [PMID: 20674242 DOI: 10.1016/j.jvs.2010.05.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/20/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pulmonary embolism (PE) is one of the major complications after percutaneous balloon angioplasty (PTBA) for Budd-Chiari's syndrome (BCS). The purpose of this study was to investigate the role of warfarin pre-treatment in the prevention of PE after PTBA in patients with large inferior vena cava (IVC) thrombus. PATIENTS AND METHODS From October 2002 to December 2009, 16 patients with symptomatic membranous or segmental IVC occlusion and large thrombus were treated with warfarin before PTBA. Eleven patients were men and 5 were women. The median age was 36 years, ranging from 21 to 52 years. The median duration of warfarin treatment before PTBA was 7 months, ranging from 3 to 12 months. Fourteen patients had membranous IVC occlusion and 2 had segmental occlusion. All 16 patients had significant thrombi underneath the obstructive lesions. PE diagnosis was based on clinical presentation and pulmonary computerized tomographic angiogram, if indicated. RESULTS In 14 of 16 patients, IVC thrombus was completely or near-completely resolved based on follow-up cavogram and PTBA was performed. In the other 2 patients, residual thrombus was demonstrated by cavogram at 12 months. PTBA and stent placement were carried out. IVC patency in the 16 patients was confirmed by completion cavogram. No major bleeding complication during warfarin pre-treatment aimed to keep international normalized ratio (INR) 2 to 3. There was no clinically significant PE or death in this group during follow-up, ranging from 6 to 40 months (median 21 months). CONCLUSION Spontaneous fibrinolysis of IVC thrombus occurs within 1 year in the majority of the patients treated with warfarin. Pre-treatment with warfarin prevents PE after PTBA in the patients with BCS with IVC membranous or segmental occlusion and large thrombus.
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Zahn A, Gotthardt D, Weiss KH, Richter G, Schmidt J, Stremmel W, Sauer P. Budd-Chiari syndrome: long term success via hepatic decompression using transjugular intrahepatic porto-systemic shunt. BMC Gastroenterol 2010; 10:25. [PMID: 20193077 PMCID: PMC2838758 DOI: 10.1186/1471-230x-10-25] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 03/01/2010] [Indexed: 12/24/2022] Open
Abstract
Background Budd-Chiari syndrome (BCS) generally implies thrombosis of the hepatic veins and/or the intrahepatic or suprahepatic inferior vena cava. Treatment depends on the underlying cause, the anatomic location, the extent of the thrombotic process and the functional capacity of the liver. It can be divided into medical treatment including anticoagulation and thrombolysis, radiological procedures such as angioplasty and transjugular intrahepatic porto-systemic shunt (TIPS) and surgical interventions including orthotopic liver transplantation (OLT). Controlled trials or reports on larger cohorts are limited due to rare disease frequency. The aim of this study was to report our single centre long term results of patients with BCS receiving one of three treatment options i.e. medication only, TIPS or OLT on an individually based decision of our local expert group. Methods 20 patients with acute, subacute or chronic BCS were treated between 1988 and 2008. Clinical records were analysed with respect to underlying disease, therapeutic interventions, complications and overall outcome. Results 16 women and 4 men with a mean age of 34 ± 12 years (range: 14-60 years) at time of diagnosis were included. Myeloproliferative disorders or a plasmatic coagulopathy were identified as underlying disease in 13 patients, in the other patients the cause of BCS remained unclear. 12 patients presented with an acute BCS, 8 with a subacute or chronic disease. 13 patients underwent TIPS, 4 patients OLT as initial therapy, 2 patients required only symptomatic therapy, and one patient died from liver failure before any specific treatment could be initiated. Eleven of 13 TIPS patients required 2.5 ± 2.4 revisions (range: 0-8). One patient died from his underlying hematologic disease. The residual 12 patients still have stable liver function not requiring OLT. All 4 patients who underwent OLT as initial treatment, required re-OLT due to thrombembolic complications of the graft. Survival in the TIPS group was 92.3% and in the OLT group 75% during a median follow-up of 4 and 11.5 years, respectively. Conclusion Our results confirm the role of TIPS in the management of patients with acute, subacute and chronic BCS. The limited number of patients with OLT does not allow to draw a meaningful conclusion. However, the underlying disease may generate major complications, a reason why OLT should be limited to patients who cannot be managed by TIPS.
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Affiliation(s)
- Alexandra Zahn
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany.
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39
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Kazimi M, Karaca C, Ozsoy M, Ozdemir M, Apaydin AZ, Ulukaya S, Zeytunlu M, Kilic M. Live donor liver transplantation for Budd-Chiari syndrome: anastomosis of the right hepatic vein to the right atrium. Liver Transpl 2009; 15:1374-7. [PMID: 19790160 DOI: 10.1002/lt.21815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Mircelal Kazimi
- Department of Surgery, Ege University Hospital, Izmir, Turkey
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40
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Schlicksup MD, Weisse CW, Berent AC, Solomon JA. Use of endovascular stents in three dogs with Budd-Chiari syndrome. J Am Vet Med Assoc 2009; 235:544-50. [DOI: 10.2460/javma.235.5.544] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Li T, Zhai S, Pang Z, Ma X, Cao H, Bai W, Wang Z, Zhang WW. Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction. J Vasc Surg 2009; 50:1079-84. [PMID: 19703746 DOI: 10.1016/j.jvs.2009.06.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study evaluated the feasibility and outcomes of percutaneous transhepatic balloon angioplasty (PTBA) of the hepatic vein in the management of Budd-Chiari syndrome (BCS) secondary to hepatic venous outflow obstruction. METHODS From September 1996 to October 2008, 101 patients (52 males, 49 females) with BCS secondary to occlusion of the hepatic veins were prospectively treated using PTBA of the hepatic vein. Average age was 31.3 years (range, 15-57 years). Nineteen had concurrent inferior vena cava (IVC) obstruction. All the patients presented with symptomatic portal hypertension. PTBA, with or without stenting, was performed after hepatovenography. RESULTS PTBA was successfully performed in 92 of the 101 patients. Sixty-eight patients underwent PTBA of right hepatic vein, followed by stent placement in two. PTBA was performed in 11 patients with left hepatic vein occlusion and in 13 patients with dominant accessory hepatic vein occlusion. The technical success rate was 92 of 101 (91%). Hepatic venous pressure was significantly decreased after balloon angioplasty/stenting (P < .01, paired t test). Symptoms were significantly improved in the 92 patients who had successful PTBA. Three patients had acute hepatic vein thrombosis during or after PTBA. Two patients sustained intraperitoneal bleeding from the transhepatic puncture track, and one had intrahepatic hematoma. Pulmonary embolism developed in one patient during the operation. All complications were managed nonoperatively. There were no perioperative deaths. Within 1 year, 74 of the 101 patients returned for follow-up, and 51 patients had follow-up at 2 years. The primary patency rates were 84% (62 of 74), 78% (58 of 74), and 76% (39 or 51) at 6, 12, and 24 months after PTBA, respectively. The secondary patency rates were 95% (70 of 74), 92% (68 of 74), and 84% (43 of 51) at 6, 12, and 24 months. CONCLUSIONS PTBA of the hepatic vein is a safe and effective treatment of BCS. It is currently the most physiologic procedure, and the risk of postoperative encephalopathy is minimized because portal flow is not diverted. Midterm outcomes are satisfactory. Further investigation of the long-term outcomes is needed.
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Affiliation(s)
- Tianxiao Li
- Department of Interventional Radiology, People's Hospital of Henan Province, Zhengzhou, Henan, Peoples Republic of China.
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Kawaguchi Y, Tashiro H, Amano H, Kobayashi T, Irei T, Igarashi Y, Ide K, Oshita A, Itamoto T, Asahara T, Ohdan H. ABO-blood type incompatible living donor liver transplantation in a patient with Budd-Chiari Syndrome secondary to essential thrombocythemia. Hepatol Res 2009; 39:520-4. [PMID: 20849569 DOI: 10.1111/j.1872-034x.2008.00470.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Budd-Chiari syndrome (BCS) results from diverse causative factors. Myeloproliferative disorders (MPDs) including essential thrombocythemia (ET) account for a minority of BCS cases in Japan. ABO-blood-type incompatible living donor liver transplantation (LDLT) in adults has become an acceptable procedure owing to the development of new strategies for preventing antibody-mediated rejection. This report presents a rare case of BCS secondary to ET, which was cured by an ABO-incompatible (AB to A) LDLT. In this case, prostaglandin E(1) and gabexate mesilate were administered into portal vein and rituximab prophylaxis was applied. No splenectomy was performed as it is in most ABO-incompatible cases, since a flow cytometry showed no anti-B antibodies in the splenocytes collected by a wedge biopsy during the LDLT. The postoperative course was uneventful. Anti-coagulation therapy was initiated with aspirin and warfarin instead of hydroxyurea. This report describes an ABO-incompatible LDLT without a splenectomy for BCS secondary to ET.
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Affiliation(s)
- Yasuo Kawaguchi
- Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Regenerative nodules in patients with chronic Budd-Chiari syndrome: a longitudinal study using multiphase contrast-enhanced multidetector CT. Eur J Radiol 2009; 73:588-93. [PMID: 19200681 DOI: 10.1016/j.ejrad.2009.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 12/18/2008] [Accepted: 01/08/2009] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Our aim was to evaluate the serial evolution of regenerative nodules in patients with Budd-Chiari syndrome (BCS) treated with portal-systemic shunts, using multiphasic multidetector computed tomography (MDCT). MATERIALS AND METHODS Five patients each underwent three MDCT exams over an extended period ranging from 36 to 42 months. Two radiologists in consensus retrospectively reviewed each exam for each patient. Individual nodules were grouped according to size (size I: nodules with diameter < or =15 mm; size II: >15 mm but <30 mm; size III: > or =30 mm), pattern of enhancement (A: homogeneously hypervascular or B: with central scar), and segmental location. Four nodules classified as size II, which increased in size over time, were needle-biopsied. RESULTS We detected 61 nodules at the first exam, 66 nodules at the second exam (7 nodules disappeared and 12 new nodules), and 85 nodules at the third exam (8 disappeared and 27 new) for a total of 212 findings. Nodules were mostly found in the right hepatic lobe. Fourteen of the 15 nodules that disappeared over time were size I and enhancement pattern A. At unenhanced MDCT, 204 (96%) of the 212 findings were isodense. Overall, 100 nodules, including the 61 initially detected, were considered newly diagnosed; of these 84 (84%) were size I and pattern A. Of 57 nodules considered size I and pattern A at the first or second exam, 24 (42%) changed to pattern B at the third exam and either size II (n=18) or III (n=6). The four biopsied nodules were each confirmed as benign regenerative nodule. No patient developed HCC at 5-year follow-up period. CONCLUSION Hepatic nodules in BCS patients not only increase in number over time but may also increase in size and develop a central scar.
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Bittencourt PL, Couto CA, Ribeiro DD. Portal vein thrombosis and budd-Chiari syndrome. Clin Liver Dis 2009; 13:127-144. [PMID: 19150317 DOI: 10.1016/j.cld.2008.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management.
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Affiliation(s)
| | - Cláudia Alves Couto
- Alfa Gastroenterology Institute, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Dias Ribeiro
- Alfa Gastroenterology Institute, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Hematology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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45
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Hiroe S, Itoh H, Matsumoto H, Takahasi S, Sato Y, Yamada S, Okagaki A, Kuzushita N, Ban C. Case of Budd-Chiari syndrome 3 months after vaginal delivery. J Obstet Gynaecol Res 2009; 34:605-8. [PMID: 18840163 DOI: 10.1111/j.1447-0756.2008.00893.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Budd-Chiari syndrome is a rather unusual clinical situation caused by occlusion of the hepatic vein of inferior vena cava, the classical triad of which are abdominal pain, ascites and hepatomegaly. A 29-year-old gravida 3 para 1 woman delivered an immature male baby weighing 2172 g with an Apgar score of 9 points at 35 weeks and 3 days of gestation. She was transferred to the National Hospital Organization Osaka National Hospital 112 days after delivery due to the sudden development of massive ascites. Magnetic resonance angiography and enhanced computed tomography detected the occlusion by thrombosis of both the middle and left hepatic veins, so she was diagnosed with Budd-Chiari syndrome. Her protein C antigen and activity were 37% and 50%, respectively, corresponding to type 1 protein C deficiency. Conservative treatment by continuous oral treatment of spironolactone (25 mg/day), furosemide (20 mg/day) and prophylactic warfarin (2 mg/day) much improved the ascites.
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Affiliation(s)
- Sasaki Hiroe
- Department of Obstetrics and Gynecology, Osaka National Hospital, Chouou-ku, Osaka, Japan
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46
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Boozari B, Bahr MJ, Kubicka S, Klempnauer J, Manns MP, Gebel M. Ultrasonography in patients with Budd-Chiari syndrome: diagnostic signs and prognostic implications. J Hepatol 2008; 49:572-80. [PMID: 18619699 DOI: 10.1016/j.jhep.2008.04.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 03/22/2008] [Accepted: 04/08/2008] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS We analyzed sonomorphological signs of Budd-Chiari syndrome (BCS) and their potential for prognosis prediction. METHODS Forty-five consecutive patients were included. Analysis included the frequencies of sonomorphological signs and their predictive value for diagnosis of BCS, mean values of laboratory and color Doppler data in different therapeutic groups and survival. RESULTS Specific ultrasound signs were identified at the level of the hepatic veins in 71% of the patients and in 33% at the level of the caval vein, i.e. thrombosis, stenosis, fibrotic cord or insufficient recanalization of the vessels. The frequent non-specific signs were splenomegaly (78%), inhomogeneous liver parenchyma (76%), intrahepatic collaterals (73%), caudate lobe hypertrophy (67%), ascites (56%) and extrahepatic collaterals (44%). The combination of specific signs and "caudate lobe hypertrophy" offered the highest predictive value to identify patients with BCS (p=0.014) with a specificity of 100%. Mean survival was significantly different between the patients with or without portal hypertension (n=25, 41.1+/-7.6, 95% CI (26.2-55.9) versus n=20, 89.4+/-4.5, 95% CI (80.5-98.2), p=0.004) and with or without portal vein thrombosis (n=12, 29.8+/-10.7, 95% CI (8.9-50.7) versus n=33, 79.3+/-6.1, 95% CI (67.4-91.1), p=0.003). CONCLUSIONS We present a comprehensive description of sonomorphological signs in BCS. The combination of ultrasound signs "altered hepatic and/or caval veins" and "caudate lobe hypertrophy" was the best strategy to diagnose BCS. Patients with portal vein thrombosis or portal hypertension have a poor prognosis.
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Affiliation(s)
- Bita Boozari
- Medical School of Hannover, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany.
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47
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Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava. AJR Am J Roentgenol 2008; 191:560-4. [PMID: 18647932 DOI: 10.2214/ajr.07.3496] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Budd-Chiari syndrome (BCS) is a clinical condition characterized by hepatic venous outflow obstruction. A transjugular intrahepatic portosystemic shunt (TIPS) is an effective means of decompressing the portal system in patients unresponsive to traditional medical therapy. TIPS may be difficult in patients with BCS owing to the presence of hepatic venous occlusive disease. We present our experience using direct percutaneous simultaneous puncture of the portal vein and the inferior vena cava to place a TIPS in patients with BCS. MATERIALS AND METHODS Between September 2003 and October 2006, percutaneous sonographically guided TIPS was performed on 11 patients (five women and a girl, four men and a boy; age range, 6-43 years). Indications for the TIPS procedure were intractable ascites in nine patients and intractable ascites and variceal bleeding in two patients. RESULTS Technical success was achieved in all patients. The mean portosystemic pressure gradient was reduced from 23.5 to 9.8 mm Hg. The cumulative rate of primary patency was 60% at 1 year. Nine revisions were performed in five patients. In nine of the 11 patients, ascites resolved completely, and in two patients, it was relieved. CONCLUSION Excellent technical and clinical success can be achieved with percutaneous sonographically guided direct simultaneous puncture of the portal vein and inferior vena cava in patients with BCS.
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48
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Treatment of Budd-Chiari syndrome with transjugular intrahepatic portosystemic shunt (TIPS). Radiol Med 2008; 113:727-38. [PMID: 18618075 DOI: 10.1007/s11547-008-0288-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 07/04/2007] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was performed to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients affected by Budd-Chiari syndrome (BCS). MATERIALS AND METHODS From January 1999 to December 2006, 15 patients (seven male and eight female subjects, age range 7-52 years) with BCS uncontrolled by medical therapy were treated with TIPS placement. In seven cases BCS was idiopathic, in four it was caused by myeloproliferative disorders and in four by other disorders. One patient also had portal vein thrombosis. In 5/15 cases TIPS was created through a transcaval approach. Eight patients (53.4%) received a bare stent, and seven (46.6%) received a stent graft. The follow-up lasted a median of 29.4 (range 3.2-68) months. RESULTS Technical success was achieved in all patients without major complications. TIPS was very effective in decreasing the portosystemic pressure gradient from 26.2+/-5.8 to 10+/-6.2 mmHg. All patients but two were alive at the time of writing. Acute leukaemia was the cause of the single early death and was unrelated to the procedure. The patient with portal vein thrombosis underwent thrombolysis before TIPS, but the vein occluded again after 3 weeks, and the patient died 6 months later. The other patients showed significant improvements in liver function, ascites and symptoms related to portal hypertension. Primary patency was 53.3%, and primary assisted patency was 93.3%. No patient required or was scheduled for liver transplantation. CONCLUSIONS TIPS is an effective and safe treatment for BCS and may be considered a valuable alternative to traditional surgical portosystemic shunting or liver transplantation.
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49
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Ben Ghorbel I, Ennaifer R, Lamloum M, Khanfir M, Miled M, Houman MH. Budd-Chiari syndrome associated with Behçet's disease. ACTA ACUST UNITED AC 2008; 32:316-20. [PMID: 18400436 DOI: 10.1016/j.gcb.2007.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Revised: 11/22/2007] [Accepted: 12/26/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Budd-Chiari syndrome is a rare and serious complication of Behçet's disease, and is the result of occlusion of the major hepatic veins, the adjacent inferior vena cava, or both. The aim of this study was to determine the prevalence, clinical and laboratory findings, and treatment and clinical course of Budd-Chiari syndrome associated with Behçet's disease. METHODS We analyzed retrospectively the charts of 220 patients fulfilling the international diagnostic criteria of Behçet's disease. From them, we selected those with Budd-Chiari syndrome, and analyzed their epidemiological and clinical imaging features and outcomes. RESULTS Seven male patients, mean age 29 years and already diagnosed with Behçet's disease, had Budd-Chiari syndrome. The clinical course was from subacute to chronic in all cases. Thrombosis of hepatic veins was associated with inferior vena cava thrombosis in six cases. Four patients had other venous thromboses (superior vena cava and lower limbs) and one also had pulmonary emboli. One patient was positive for anticardiolipin antibodies. All patients had anticoagulation therapy, and six had high-dose corticotherapy associated, in two cases, with monthly cyclophosphamid intravenous pulses. Clinical outcome was favourable in six cases, and one patient died of hepatic failure. CONCLUSION The prevalence of Budd-Chiari syndrome in patients with Behçet's disease is 3.2%, confirming that this syndrome is not uncommon in Behçet's patients. The inferior vena cava is frequently involved in combination with hepatic veins and often associated with other venous thrombosis. The prognosis may be favorable with medical interventions, including anticoagulation, treatment of the vasculitis and the use of diuretics when required.
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Affiliation(s)
- I Ben Ghorbel
- Department of Internal Medicine, La Rabta Hospital, 1007 Jabbari Tunis, Tunisia
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50
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Horton JD, San Miguel FL, Membreno F, Wright F, Paima J, Foster P, Ortiz JA. Budd-Chiari syndrome: illustrated review of current management. Liver Int 2008; 28:455-66. [PMID: 18339072 DOI: 10.1111/j.1478-3231.2008.01684.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atriocaval junction. BCS is a complex disease with a wide spectrum of aetiologies and presentations. This article reviews the current literature with respect to presentation, management and prognosis of the disease. Medical, interventional and surgical management of BCS is discussed. Particular attention is paid to interventional and surgical aspects of management. The review is augmented by images, which provide a clinical corollary to the text.
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Affiliation(s)
- John D Horton
- William Beaumont Army Medical Center, Department of Surgery, El Paso, TX 79920-5001, USA.
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