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Changes in arterial oxygenation after portal decompression in Budd–Chiari syndrome patients with hepatopulmonary syndrome

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the changes in arterial oxygenation after portal decompression in Budd–Chiari syndrome (BCS) patients with hepatopulmonary syndrome (HPS).

Methods

From June 2014 to June 2015, all patients with BCS who underwent balloon angioplasty or transjugular intrahepatic portosystemic shunt (TIPS) creation at our institution were eligible for inclusion in this study. Arterial blood gas analysis was performed with the patient in an upright position and breathing room air at 2–3 days and 1 and 3 months after the procedure.

Results

Eleven patients with HPS and 14 patients without HPS were included in this study. The procedure was technically successful in 24 patients. One patient with HPS had technically unsuccessful TIPS creation. Reobstruction or TIPS dysfunction was not detected in any patient within 3 months after the procedure. For patients with HPS, the alveolar–arterial oxygen gradient (A-aO2) remained comparable to baseline 2–3 days after the procedure (-3.2 ± 11.9 mmHg; p = .412), significantly improved 1 month after the procedure (-11.7 ± 6.4 mmHg; p < .001), and then returned to baseline 3 months after the procedure (-1.3 ± 12.5 mmHg; p = .757). For patients without HPS, the A-aO2 remained comparable to baseline at all three time points after the procedure (+1.4 ± 8.3 mmHg, +3.5 ± 8.1 mmHg, and +1.3 ± 8.2 mmHg; p = .543, p = .137, and p = .565).

Conclusions

Arterial oxygenation transiently improves after portal decompression in BCS patients with HPS.

Key Points

• Intrapulmonary vascular dilation and hepatopulmonary syndrome are common in patients with Budd–Chiari syndrome.

• Arterial oxygenation transiently improves after portal decompression in Budd–Chiari syndrome patients with hepatopulmonary syndrome.

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Abbreviations

A-aO2 :

Alveolar–arterial oxygen gradient

ABG:

Arterial blood gas

BCS:

Budd–Chiari syndrome

CEE:

Contrast-enhanced echocardiography

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

HPS:

Hepatopulmonary syndrome

HV:

Hepatic veins

IPVD:

Intrapulmonary vascular dilation

IVC:

Inferior vena cava

LT:

Liver transplantation

PaCO2 :

Arterial partial pressure of carbon dioxide

PaO2 :

Arterial partial pressure of oxygen

TIPS:

Transjugular intrahepatic portosystemic shunt

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Funding

This study was supported by the National Key R&D Program of China (grant no. 2017YFC0107804).

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Authors and Affiliations

  1. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Jiaywei Tsauo, He Zhao, Xiaowu Zhang & Xiao Li

  2. Institute of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Huaiyuan Ma, Mingshan Jiang, Ningna Weng & Xiao Li

Authors
  1. Jiaywei Tsauo
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  2. He Zhao
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  3. Xiaowu Zhang
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  4. Huaiyuan Ma
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  5. Mingshan Jiang
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  6. Ningna Weng
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  7. Xiao Li
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Corresponding author

Correspondence to Xiao Li.

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Guarantor

The scientific guarantor of this publication is Xiao Li.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The subjects who underwent TIPS creation in this cohort have been included in another manuscript submitted elsewhere for publication.

Methodology

• Prospective

• Observational study

• Performed at one institution

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Tsauo, J., Zhao, H., Zhang, X. et al. Changes in arterial oxygenation after portal decompression in Budd–Chiari syndrome patients with hepatopulmonary syndrome. Eur Radiol 29, 3273–3280 (2019). https://doi.org/10.1007/s00330-018-5840-1

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  • DOI: https://doi.org/10.1007/s00330-018-5840-1

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