Direct Intrahepatic Portosystemic Shunt in Budd-Chiari Syndrome: A Case Report and Review of the Literature

Overview

Journal Case Rep Radiol

Publisher Wiley

Specialty Radiology

Date 2018 Sep 14

PMID 30210895

Citations 2

Authors

V Chandra

E Wajswol

M Shahid

A Kumar

S Contractor

Affiliations

Soon will be listed here.

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Typically, DIPS involves the use of transabdominal ultrasound to target the portal vein. Herein a case in which a 39-year-old female underwent DIPS without the use of ultrasound guidance is presented. Instead, a hepatic venogram generated using collateral circulation was used to opacify and guide access to the portal vein.

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References

Murad S, Plessier A, Hernandez-Guerra M, Fabris F, Eapen C, Bahr M . Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med. 2009; 151(3):167-75. DOI: 10.7326/0003-4819-151-3-200908040-00004. View

Perello A, Garcia-Pagan J, Gilabert R, Suarez Y, Moitinho E, Cervantes F . TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy. Hepatology. 2002; 35(1):132-9. DOI: 10.1053/jhep.2002.30274. View

Sharma V, Ranade P, Marar S, Nabi F, Nagral A . Long-term clinical outcome of Budd-Chiari syndrome in children after radiological intervention. Eur J Gastroenterol Hepatol. 2016; 28(5):567-75. DOI: 10.1097/MEG.0000000000000583. View

Wu T, Wang L, Xiao Q, Wang B, Li S, Li X . Percutaneous balloon angioplasty of inferior vena cava in Budd-Chiari syndrome-R1. Int J Cardiol. 2002; 83(2):175-8. DOI: 10.1016/s0167-5273(02)00037-2. View

TAVILL A, Wood E, Kreel L, Jones E, Gregory M, Sherlock S . The Budd-Chiari syndrome: correlation between hepatic scintigraphy and the clinical, radiological, and pathological findings in nineteen cases of hepatic venous outflow obstruction. Gastroenterology. 1975; 68(3):509-18. View

DeLeve L, Valla D, Garcia-Tsao G . Vascular disorders of the liver. Hepatology. 2009; 49(5):1729-64. PMC: 6697263. DOI: 10.1002/hep.22772. View

Petersen B, Clark T . Direct intrahepatic portocaval shunt. Tech Vasc Interv Radiol. 2009; 11(4):230-4. DOI: 10.1053/j.tvir.2009.04.006. View

Boyvat F, Harman A, Ozyer U, Aytekin C, Arat Z . Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava. AJR Am J Roentgenol. 2008; 191(2):560-4. DOI: 10.2214/AJR.07.3496. View

Han G, Qi X, Zhang W, He C, Yin Z, Wang J . Percutaneous recanalization for Budd-Chiari syndrome: an 11-year retrospective study on patency and survival in 177 Chinese patients from a single center. Radiology. 2012; 266(2):657-67. DOI: 10.1148/radiol.12120856. View

10.

Qi X, Guo X, Fan D . Difference in Budd-Chiari syndrome between the West and China. Hepatology. 2014; 62(2):656. DOI: 10.1002/hep.27628. View

11.

Janssen H, Garcia-Pagan J, Elias E, Mentha G, Hadengue A, Valla D . Budd-Chiari syndrome: a review by an expert panel. J Hepatol. 2003; 38(3):364-71. DOI: 10.1016/s0168-8278(02)00434-8. View

12.

Menon K, Shah V, Kamath P . The Budd-Chiari syndrome. N Engl J Med. 2004; 350(6):578-85. DOI: 10.1056/NEJMra020282. View

13.

Yang X, Cheng T, Chen C . Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study. J Am Coll Cardiol. 1996; 28(7):1720-4. DOI: 10.1016/S0735-1097(96)00385-3. View

14.

Witte A, Kool L, Veenendaal R, Lamers C, Van Hoek B . Hepatic vein stenting for Budd-Chiari syndrome. Am J Gastroenterol. 1997; 92(3):498-501. View

15.

Petersen B, Binkert C . Intravascular ultrasound-guided direct intrahepatic portacaval shunt: midterm follow-up. J Vasc Interv Radiol. 2004; 15(9):927-38. DOI: 10.1097/01.RVI.0000133703.35041.42. View

16.

Eapen C, Velissaris D, Heydtmann M, Gunson B, Olliff S, Elias E . Favourable medium term outcome following hepatic vein recanalisation and/or transjugular intrahepatic portosystemic shunt for Budd Chiari syndrome. Gut. 2005; 55(6):878-84. PMC: 1856218. DOI: 10.1136/gut.2005.071423. View

17.

Lim J, Park J, Auh Y . Membranous obstruction of the inferior vena cava: comparison of findings at sonography, CT, and venography. AJR Am J Roentgenol. 1992; 159(3):515-20. DOI: 10.2214/ajr.159.3.1503015. View

18.

Xue H, Li Y, Shakya P, Palikhe M, Jha R . The role of intravascular intervention in the management of Budd-Chiari syndrome. Dig Dis Sci. 2009; 55(9):2659-63. DOI: 10.1007/s10620-009-1087-7. View

19.

Hatzidakis A, Galanakis N, Kehagias E, Samonakis D, Koulentaki M, Matrella E . Ultrasound-guided direct intrahepatic portosystemic shunt in patients with Budd-Chiari syndrome: Short- and long-term results. Interv Med Appl Sci. 2017; 9(2):86-93. PMC: 5598128. DOI: 10.1556/1646.9.2017.2.14. View

20.

Bozorgmanesh A, Selvam D, Caridi J . Budd-Chiari syndrome: hepatic venous web outflow obstruction treated by percutaneous placement of hepatic vein stent. Semin Intervent Radiol. 2011; 24(1):100-5. PMC: 3036335. DOI: 10.1055/s-2007-971200. View