Advertisement

Digestive Diseases and Sciences

, Volume 61, Issue 10, pp 3054–3060 | Cite as

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

  • Xinxin Fan
  • Kai Liu
  • Yuan Che
  • Shikai Wang
  • Xingjiang WuEmail author
  • Jianmin Cao
  • Jieshou Li
Original Article

Abstract

Background

Budd–Chiari syndrome (BCS) with hepatic vein (HV) occlusion is manifested by severe liver damage in acute cases and esophageal variceal bleeding or refractory ascites in chronic cases, which is difficult to differentiate from cirrhotic portal hypertension.

Aims

To evaluate the clinical efficacy and safety of HV angioplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of BCS with HV occlusion.

Methods

Between May 1995 and December 2014, 60 patients with HV occlusive BCS underwent HV angioplasty or TIPS. BCS was subacute or chronic in 55 patients and acute in 5 patients. HV angioplasty was performed in 18 patients with HV occlusion, combined HV and IVC angioplasty in 9 patients with HV and IVC occlusion, TIPS in 12 patients with HV occlusion, and modified TIPS in 21 patients with extensive HV occlusion.

Results

The interventional procedure was successfully performed in all 60 patients. The portal pressure decreased from 41.23 ± 10.46 cmH2O preoperatively to 26.68 ± 6.46 cmH2O postoperatively, while the portal flow velocity increased from 14.31 ± 10.43 to 52.16 ± 13.68 cm/s in patients undergoing TIPS or modified TIPS. During hospitalization, two patients died from hepatic failure, and acute shunt occlusion occurred in two other patients during subsequent treatment with repeated intervention. During 82.25 ± 46.16 months of follow-up, three patients underwent re-intervention with a stenotic shunt, and other three with repeated dilation of the stenotic HV.

Conclusion

HV angioplasty and TIPS yield excellent long-term outcomes in patients with HV occlusive BCS.

Keywords

Balloon angioplasty Transjugular intrahepatic portoasystemic shunt Budd–Chiari syndrome Hepatic veins 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Plessier A, Valla D-C. Budd–Chiari syndrome. Semin Liver Dis. 2008;28:259–269.CrossRefPubMedGoogle Scholar
  2. 2.
    Zhang Q, Xu H, Zu M, et al. Strategy and long-term outcomes of endovascular treatment for Budd–Chiari syndrome complicated by inferior vena caval thrombosis. Eur J Vasc Endovasc Surg. 2014;47:550–557.CrossRefPubMedGoogle Scholar
  3. 3.
    Nunez O, de la Cruz G, Molina J, et al. Interventional radiology, angioplasty and TIPS in Budd–Chiari syndrome. Gastroenterol Hepatol. 2003;26:461–464.CrossRefPubMedGoogle Scholar
  4. 4.
    Rössle M, Olschewski M, Siegerstetter V, Berger E, Kurz K, Grandt D. The Budd–Chiari syndrome: outcome after treatment with the transjugular intrahepatic portosystemic shunt. Surgery. 2004;135:394–403.CrossRefPubMedGoogle Scholar
  5. 5.
    Rosenqvist K, Sheikhi R, Eriksson L-G, et al. Endovascular treatment of symptomatic Budd–Chiari syndrome-in favour of early transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol. 2016;28:656–660.CrossRefPubMedGoogle Scholar
  6. 6.
    Ludwig J, Hashimoto E, McGill DB, van Heerden JA. Classification of hepatic venous outflow obstruction: ambiguous terminology of the Budd–Chiari syndrome. In: Mayo Clinic Proceedings. Amsterdam: Elsevier; 1990:51–55.Google Scholar
  7. 7.
    Zhou W-J, Cui Y-F, Zu M-H, Zhang Q-Q, Xu H. Budd–Chiari syndrome in young chinese: clinical characteristics, etiology and outcome of recanalization from a single center. Cardiovasc Interv Radiol. 2016;39:557–565.CrossRefGoogle Scholar
  8. 8.
    Cazals-Hatem D, Vilgrain V, Genin P, et al. Arterial and portal circulation and parenchymal changes in Budd–Chiari syndrome: a study in 17 explanted livers. Hepatology.. 2003;37:510–519.CrossRefPubMedGoogle Scholar
  9. 9.
    Goel RM, Johnston EL, Patel KV, Wong T. Budd–Chiari syndrome: investigation, treatment and outcomes. Postgrad Med J. 2015:postgradmedj-2015-133402.Google Scholar
  10. 10.
    Brancatelli G, Vilgrain V, Federle MP, et al. Budd–Chiari syndrome: spectrum of imaging findings. Am J Roentgenol. 2007;188:W168–W176.CrossRefGoogle Scholar
  11. 11.
    Meng X-C, Zhu K-S, Qin J, et al. Clinical significance of multislice spiral CT scans in hepatic veins occlusion in Budd–Chiari syndrome. Chin Med J. 2007;120:100–105.PubMedGoogle Scholar
  12. 12.
    Zhou P, Ren J, Han X, et al. Initial imaging analysis of Budd–Chiari syndrome in Henan province of China: most cases have combined inferior vena cava and hepatic veins involvement. PloS One. 2014;9:e85135.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kane R, Eustace S. Diagnosis of Budd–Chiari syndrome: comparison between sonography and MR angiography. Radiology. 1995;195:117–121.CrossRefPubMedGoogle Scholar
  14. 14.
    Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd–Chiari syndrome with a step-wise management. Hepatology. 2013;57:1962–1968.CrossRefPubMedGoogle Scholar
  15. 15.
    Wei X, Hao X, Da-Hai Y, Mao-Heng Z, Qing-Qiao Z, Yu-Ming G. Analysis of interventional treatments of Budd–Chiari Syndrome and the related complications: a study of 1006 cases. Panminerva medica. 2013;55:371–376.PubMedGoogle Scholar
  16. 16.
    Pelage J-P, Denys A, Valla D, et al. Budd–Chiari syndrome due to prothrombotic disorder: mid-term patency and efficacy of endovascular stents. Eur Radiol. 2003;13:286–293.PubMedGoogle Scholar
  17. 17.
    Li T, Zhai S, Pang Z, et al. Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd–Chiari syndrome secondary to hepatic venous obstruction. J Vasc Surg. 2009;50:1079–1084.CrossRefPubMedGoogle Scholar
  18. 18.
    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;31:222–228.CrossRefPubMedGoogle Scholar
  19. 19.
    Mancuso A. An update on the management of Budd–Chiari syndrome: the issues of timing and choice of treatment. Eur J Gastroenterol Hepatol. 2015;27:200–203.CrossRefPubMedGoogle Scholar
  20. 20.
    Langlet P, Valla D. Is surgical portosystemic shunt the treatment of choice in Budd–Chiari syndrome? Acta gastro-enterol Belgica. 2002;65:155–160.Google Scholar
  21. 21.
    Fu Y-F, Xu H, Wu Q, Zhang Q-Q, Cui Y-F, Wei N. Combined thrombus aspiration and recanalization in treating Budd–Chiari syndrome with inferior vena cava thrombosis. La Radiol Med. 2015;120:1094–1099.CrossRefGoogle Scholar
  22. 22.
    Molmenti EP, Segev DL, Arepally A, et al. The utility of TIPS in the management of Budd–Chiari syndrome. Ann Surg. 2005;241:978–983.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gasparini D, Del Forno M, Sponza M, et al. Transjugular intrahepatic portosystemic shunt by direct transcaval approach in patients with acute and hyperacute Budd–Chiari syndrome. Eur J Gastroenterol Hepatol. 2002;14:567–571.CrossRefPubMedGoogle Scholar
  24. 24.
    Hernández-Guerra M, Turnes J, Rubinstein P, et al. PTFE-covered stents improve TIPS patency in Budd–Chiari syndrome. Hepatology. 2004;40:1197–1202.CrossRefPubMedGoogle Scholar
  25. 25.
    Perry BC, Kwan SW. Portosystemic shunts: stable utilization and improved outcomes, two decades after the transjugular intrahepatic portosystemic shunt. J Am Coll Radiol. 2015;12:1427–1433.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mancuso A, Fung K, Mela M, et al. TIPS for acute and chronic Budd–Chiari syndrome: a single-centre experience. J Hepatol. 2003;38:751–754.CrossRefPubMedGoogle Scholar
  27. 27.
    Tripathi D, Macnicholas R, Kothari C, et al. Good clinical outcomes following transjugular intrahepatic portosystemic stent-shunts in Budd–Chiari syndrome. Aliment Pharmacol Ther. 2014;39:864–872.CrossRefPubMedGoogle Scholar
  28. 28.
    Wu X, Ding W, Cao J, Han J, Li J. Modified transjugular intrahepatic portosystemic shunt in the treatment of Budd–Chiari syndrome. Int J Clin Pract. 2010;64:460–464.CrossRefPubMedGoogle Scholar
  29. 29.
    Plessier A, Sibert A, Consigny Y, et al. Aiming at minimal invasiveness as a therapeutic strategy for Budd–Chiari syndrome. Hepatology. 2006;44:1308–1316.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Xinxin Fan
    • 1
  • Kai Liu
    • 1
  • Yuan Che
    • 1
  • Shikai Wang
    • 1
  • Xingjiang Wu
    • 1
    Email author
  • Jianmin Cao
    • 2
  • Jieshou Li
    • 1
  1. 1.Department of General Surgery, Jinling HospitalMedical School of Nanjing UniversityNanjingPeople’s Republic of China
  2. 2.Department of Medical Imaging, Jinling HospitalMedical School of Nanjing UniversityNanjingPeople’s Republic of China

Personalised recommendations