Budd-Chiari syndrome and acute portal vein thrombosis: management by a transjugular intrahepatic portosystemic shunt (TIPS) and portal vein interventions via a TIPS

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Isaac KoriMenahem Ben-Haim

Abstract

Acute portal vein thrombosis (PVT) is a devastating complication of Budd-Chiari syndrome (BCS). Conservative approach, anticoagulation, systemic or transarterial thrombolysis, and urgent liver transplantation were applied in this scenario but with poor results. We present and discuss an approach to treat BCS complicated by acute PVT. Two young female patients presented with acute liver failure, rapidly progressive tense ascites, renal- and respiratory failure. The diagnosis of chronic BCS complicated by acute PVT was confirmed with ultrasound Doppler. Initial treatment was supportive. Right portal vein localization was by transarterial portogram or by computed tomography-guided microcoil placement. Transjugular intrahepatic portosystemic shunt (TIPS) was performed and included Wallstents and a Jograft in one case and Viatorr stentgraft that was extended later with a Hemobahn stentgraft in another. Mechanical clot removal from the portal system was performed in the primary procedure and in a revision procedure in the following few days. Stents were placed precisely with no extension into the inferior vena cava or deeply into the main portal vein. Patients were fully anticoagulated and patency was assessed by ultrasound Doppler. ...Continue Reading

Citations

Oct 28, 2009·World Journal of Gastroenterology : WJG·Feng-Yong LiuPeng Song
Mar 6, 2008·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·William M LeeJay H Hoofnagle
Jan 25, 2008·Cardiovascular and Interventional Radiology·David Beckett, Simon Olliff

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