Percutaneous transhepatic TIPS for Budd-Chiari syndrome as a bridge to liver transplantation
Fatih Boyvat1, Ali Harman1, Ebru H. Ayvazoglu Soy2, Ozgur Ozen1, Aydincan Akdur2, Gokhan Moray2, Mehmet Haberal2.
1Department of Radiology, Baskent University, Ankara, Turkey; 2Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey
Purpose: To evaluate the effectiveness of percutaneous transhepatic direct simultaneous puncture of portal vein and inferior vena cava in Budd-Chiari syndrome and the clinical outcomes.
Material and Methods: From January 2006 to January 2022, we performed TIPS in 65 consecutive patients (mean age, 33 years) with BCS (8 patients with acute BCS and 57 patients with subacute and chronic BCS). Doppler US was performed first day, one week, one month and then 3 months apart. Portography and pressure measurements were performed every year if no shunt dysfunction was detected before. Mean follow-up of 52 months (range, 6 months -119 months).
Results: TIPS procedure was technically successful in all patients. In all patients, bare stents were used. Patients were anticoagulated with warfarin after TIPS procedure. Early thrombosis (in one week) was diagnosed in 13 (20%) patients and TIPS revision was required. One year primary patency was 65.2%. Clinical success was achieved in 60 patients. 5 patients required liver transplantation because of liver function deterioration but only 3 of them had liver transplantation(7months, 1.5 year and 2 year later from TIPS) other 2 patients died while in the waiting list.
Conclusion: Percutaneous direct puncture of portal vein and inferior vena cava is safe and effective in patients with Budd-Chiari syndrome. This procedure may provide an effective alternative for the management of Budd-Chiari patients that necessitates TIPS. Close follow-up and second intervention is necessary to get good clinical outcome.
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