Modified transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome

Aims: The aim of this study was to determine the outcome of a modified transjugular intrahepatic portosystemic shunt (MTIPS) in the treatment of the Budd-Chiari syndrome (BCS, occlusion of the hepatic veins). Methods: Eleven patients with severe BCS were selected for MTIPS treatment. Three patients had an acute history (< 2 months) and eight had a subacute or a chronic course of the disease. All patients were associated with variceal bleeding and massive ascites. The diagnosis of BCS was established by duplex sonography, computed tomography scan, magnetic resonance imaging, angiography of hepatic veins and inferior vena cava, and liver biopsy. The shunt was established using conventional self-expandable stents with diameter of 10 cm in all patients. The mean follow-up was 60.55 +/- 42.76 months. Results: The shunt reduced the portosystemic pressure gradient from 30.32 +/- 7.69 to 9.08 +/- 3.43 mmHg and improved the portal flow velocity from 11.24 +/- 2.75 to 52.16 +/- 13.68 cm/s. Clinical symptoms as well as the biochemical test results improved significantly during 3 weeks after shunt treatment except for one death caused by hepatic failure. Ten patients are alive without clinical symptoms. Three revisions in two patients were needed during the follow-up. The inflation of stenosised shunt was performed in one patient, and the inflation of stenosised shunt and the reimplantation of stent in another patient. The other eight patients had no revisions. Conclusions: Modified transjugular intrahepatic portosystemic shunt provides an excellent outcome in patients with BCS (occlusion of the hepatic veins). It may be regarded as an option for the acute and long-term managements of these patients.