There has been significant improvement in understanding the etiology and management of
Budd-Chiari Syndrome (BCS). Patients with chronic or acute-on-chronic BCS need radiological interventions in the form of angioplasty, hepatic vein/inferior vena cava stenting or Transjugular Intrahepatic
Portosystemic Shunt (
TIPS). Data regarding the long term follow up of patients undergoing
TIPS is limited. We thus prospectively followed-up BCS patients who underwent
TIPS at our center.
METHODS: This study included 42 patients with BCS who underwent
TIPS with a covered
stent between 2004 and 2014. We analyzed the etiology, symptoms, severity, laboratory parameters and imaging pre and post
TIPS. All patients underwent surveillance for
hepatocellular carcinoma.
RESULTS: Patients demographics included 26 males and 16 females with a mean age of 40.5 years (19-68 years). The mean Model for
End-Stage Liver Disease score of the entire cohort was 15.38 (range: 9-25). Thirty-four patients were grouped into Rotterdam Class 2 and remaining into Class 3. There was significant improvement in
ascites, gastrointestinal bleed, renal function and
transaminase levels post
TIPS. There were 11 deaths over the follow-up period - 4 within one month, 2 within six months and the rest after 3 years following
TIPS. Median duration from clinical presentation to
TIPS was 2.1 weeks and median survival till follow-up was 45.5 months (0-130 months). 33/42 patients underwent
TIPS prior to 2013, and their median survival till follow-up was 55 months. Six out of eleven deaths that occurred within six months post-
TIPS were before 2006; when the technique of
TIPS creation was evolving. The cumulative 1 year, 5 years and 10 years OLT-free survival was 86%, 81% and 76%, respectively. Two patients underwent a
liver transplant at 4 and 7 years after
TIPS.
CONCLUSION: