[Budd-Chiari syndrome and TIPS--twelve years' experience]

Area of Science:

• Hepatology
• Interventional Radiology
• Vascular Surgery

Context:

• Budd-Chiari syndrome (BCS) with massive hepatic vein thrombosis presents a severe clinical challenge.
• Ischemic liver impairment is critical in acute BCS, necessitating prompt restoration of hepatic blood drainage.
• Chronic BCS often leads to complications like ascites, gastrointestinal bleeding, and hepatorenal syndrome due to portal hypertension.

Purpose:

• To evaluate the clinical outcomes of patients with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt (TIPS).
• To assess the efficacy and safety of TIPS as a therapeutic intervention for massive hepatic vein thrombosis.
• To compare the use of bare stents versus ePTFE-covered stents in TIPS procedures for BCS.

Summary:

• Twenty-three patients with hepatic vein thrombosis underwent TIPS over 12 years, with a median age of 33.3 years; one-third of procedures were urgent.
• Thrombosis was linked to myeloproliferative syndrome in two-thirds of cases; ePTFE-covered stents reduced late stenoses and occlusions compared to bare stents.
• Seventeen surviving patients maintained good condition with functional shunts, requiring anticoagulant therapy and intermittent reinterventions, with covered stents showing improved long-term patency.

Impact:

• TIPS is considered an advantageous therapeutic approach for Budd-Chiari syndrome, improving liver perfusion and function.
• Rigorous follow-up and management, including anticoagulant therapy and reinterventions, are crucial for long-term TIPS success.
• TIPS may serve as a viable alternative to liver transplantation in select BCS patients, potentially sparing them from a major surgical procedure.