Abstract
Background
The role of portosystemic shunting in the treatment of the Budd-Chiari syndrome is
still under debate. Medical therapy and liver transplantation are alternative treatments.
The aim of this study was to determine the outcome of a transjugular intrahepatic
portosystemic shunt implantation.
Methods
Thirty-five patients with severe Budd-Chiari syndrome and a Child-Pugh score of 9.2±1.9,
who were not responsive to medical therapy, were elected for the transjugular shunt
treatment, which was successfully accomplished in 33. Eleven patients had a fulminant/acute
(history <2 months); 13, a subacute (<6 months); and 11, a chronic course of the disease.
The shunt was established by using conventional self-expandable stents in 25 patients
and polytetrafluoroethylene-covered stents in 8 patients. The mean follow-up was 37±29
months.
Results
The shunt reduced the portosystemic pressure gradient from 29±7 to 10±4 mm Hg and
improved the portal flow velocity from 9.2±11 to 51±17 cm/s. Clinical symptoms as
well as the biochemical test results improved significantly during 4 weeks after shunt
treatment. Three patients died and 2 received liver transplants. The cumulative 1-
and 5-year survival rate without transplantation in all patients was 93% and 74%,
respectively, and in patients with fulminant/acute disease 91% and 91% respectively
(no deaths in this time period). On the average, 1.4±2.2 revisions per patient were
needed during the mean follow-up of 3 years with a 1-year probability of 47%.
Conclusions
The transjugular shunt provides an excellent outcome in patients with severe fulminant/acute,
subacute, and chronic Budd-Chiari syndrome. It may be regarded as a treatment for
the acute and long-term management of these patients.
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Article info
Publication history
Accepted:
August 18,
2003
Freiburg and Saarbrücken, GermanyIdentification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
