Long-Term Follow-Up After Successful Transjugular Intrahepatic Portosystemic Shunt Placement in a Pediatric Patient with Budd-Chiari Syndrome

  • Francisco César CarnevaleEmail author
  • Denis Szejnfeld
  • Airton Mota Moreira
  • Nelson Gibelli
  • Miguel Angel De Gregório
  • Uenis Tannuri
  • Giovanni Guido Cerri
Case Report


Orthotopic liver transplantation is the standard of care in patients with Budd-Chiari syndrome (BCS), and transjugular intrahepatic portosystemic shunt (TIPS) has become an important adjunct procedure while the patient is waiting for a liver. No long-term follow up of TIPS in BCS patients has been published in children. We report successful 10-year follow-up of a child with BCS and iatrogenic TIPS dysfunction caused by oral contraceptive use.


Interventional radiology Budd-Chiari syndrome Transjugular intrahepatic portasystemic shunt 


  1. 1.
    Ahn SS, Yellin A, Sheng FC, Colonna JO, Goldstein LI, Busuttil RW (1987) Selective surgical therapy of the Budd-Chiari syndrome provides superior survivor rates than conservative medical management. J Vasc Surg 5:28–37PubMedCrossRefGoogle Scholar
  2. 2.
    Bismuth H, Sherlock DJ (1991) Portasystemic shunting versus liver transplantation for the Budd-Chiari syndrome. Ann Surg 214:581–589PubMedCrossRefGoogle Scholar
  3. 3.
    Peltzer MY, Ring EJ, LaBerge JM, Haskal ZJ, Radosevich PM, Gordon RL (1993) Treatment of Budd-Chiari syndrome with a transjugular intrahepatic portosystemic shunt. J Vasc Intervent Radiol 4:263–267CrossRefGoogle Scholar
  4. 4.
    Ochs A, Sellinger M, Haag K et al (1993) Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome. J Hepatol 18:217–225PubMedCrossRefGoogle Scholar
  5. 5.
    Ganger DR, Klapman JB, McDonald V et al (1999) Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: review of indications and problems. Am J Gastroenterol 94:603–608PubMedGoogle Scholar
  6. 6.
    Carnevale FC, Caldas JG, Maksoud JG (2002) Transjugular intrahepatic portosystemic shunt in a child with Budd-Chiari syndrome: technical modification and extended followup. Cardiovasc Intervent Radiol 25:224–226PubMedCrossRefGoogle Scholar
  7. 7.
    Boyvat F, Aytekin C, Harman A, Ozin Y (2006) Transjugular intrahepatic portosystemic shunt creation in Budd-Chiari syndrome: percutaneous ultrasound-guided direct simultaneous puncture of the portal vein and vena cava. Cardiovasc Intervent Radiol 29:857–861PubMedCrossRefGoogle Scholar
  8. 8.
    Quateen A, Pech M, Berg T et al (2006) Percutaneous transjugular direct porto-caval shunt in patients with Budd-Chiari syndrome. Cardiovasc Intervent Radiol 29:565–570PubMedCrossRefGoogle Scholar
  9. 9.
    Gandini R, Konda D, Simonetti G (2006) Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd-Chiari syndrome: covered versus uncovered stents. Radiology 241:298–305PubMedCrossRefGoogle Scholar
  10. 10.
    Rossle M, Siegerstetter V, Euringer W et al (2006) The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): long-term follow-up of 100 patients. Acta Radiol 47:660–666PubMedCrossRefGoogle Scholar
  11. 11.
    Xu PQ, Ma XX, Ye XX et al (2004) Surgical treatment of 1360 cases of Budd-Chiari syndrome: 20-year experience. Hepatobiliary Pancreat Dis Int 3:391–394PubMedGoogle Scholar
  12. 12.
    Orloff MJ, Daily PO, Orloff SL, Girard B, Orloff MS (2000) A 27-year experience with surgical treatment of Budd-Chiari syndrome. Ann Surg 232:340–352PubMedCrossRefGoogle Scholar
  13. 13.
    Ruckert JC, Ruckert RI, Rudolph B, Muller JM (1999) Recurrence of the Budd-Chiari syndrome after orthotopic liver transplantation. Hepatogastroenterology 46:867–871PubMedGoogle Scholar
  14. 14.
    Khuroo MS, Al-Suhabani H, Al-Sebayel M et al (2005) Budd-Chiari syndrome: long-term effect on outcome with transjugular intrahepatic portosystemic shunt. J Gastroenterol Hepatol 20:1494–1502PubMedCrossRefGoogle Scholar
  15. 15.
    Terreni N, Vangeli M, Raimondo ML, Tibballs JM, Patch D, Burroughs AK (2007) Late intrahepatic hematoma complicating transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome. Cardiovasc Intervent Radiol 30:335–338PubMedCrossRefGoogle Scholar
  16. 16.
    Ecker JA, McKittrick JE, Failing RM (1996) Thrombosis of the hepatic veins. The Budd-Chiari syndrome—a possible link between oral contraceptives and thrombosis formation. Am J Gastroenterol 45:429–443Google Scholar
  17. 17.
    Minnema MC, Janssen HL, Niermeijer P, de Man RA (2000) Budd-Chiari syndrome: combination of genetic defects and the use of oral contraceptives leading to hypercoagulability. J Hepatol 33:509–512PubMedCrossRefGoogle Scholar
  18. 18.
    Maddrey WC (1987) Hepatic vein thrombosis (Budd Chiari syndrome): possible association with the use of oral contraceptives. Semin Liver Dis 7:32–39PubMedCrossRefGoogle Scholar
  19. 19.
    Lewis JH, Tice HL, Zimmerman HJ (1983) Budd-Chiari syndrome associated with oral contraceptive steroids. Review of treatment of 47 cases. Dig Dis Sci 28:673–683PubMedCrossRefGoogle Scholar
  20. 20.
    Verma A, Sharma G, Mohan S, Saraswat VA, Baijal SS (2008) TIPS can be lifesaving in acute liver failure associated with portal vein and inferior vena cava thrombosis in a case of Budd Chiari syndrome due to protein S deficiency. Cardiovasc Intervent Radiol 31(Suppl 2):S197–S199Google Scholar
  21. 21.
    Nunez O, de la Cruz G, Molina J et al (2003) Interventional radiology, angioplasty and TIPS in Budd-Chiari syndrome. Gastroenterol Hepatol 26:461–464PubMedCrossRefGoogle Scholar
  22. 22.
    Rossle M, Olschewski M, Siegerstetter V, Berger E, Kurz K, Grandt D (2004) The Budd-Chiari syndrome: outcome after treatment with the transjugular intrahepatic portosystemic shunt. Surgery 135:394–403PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Francisco César Carnevale
    • 1
    • 3
    Email author
  • Denis Szejnfeld
    • 1
  • Airton Mota Moreira
    • 1
  • Nelson Gibelli
    • 4
  • Miguel Angel De Gregório
    • 2
  • Uenis Tannuri
    • 4
  • Giovanni Guido Cerri
    • 1
  1. 1.Service of Interventional Radiology, Instituto de RadiologiaUniversity of Sao Paulo Medical SchoolSao PauloBrazil
  2. 2.Interventional Radiology UnitUniversity of ZaragozaZaragozaSpain
  3. 3.Sao PauloBrazil
  4. 4.Service of Pediatric Surgery, Instituto da Criança Prof. Pedro de AlcantaraUniversity of Sao Paulo Medical SchoolSao PauloBrazil

Personalised recommendations