Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis - Review of indications and problems

OBJECTIVE: The aim of this study was to evaluate the role of transjugular i ntrahepatic portosystemic shunt (TIPS) in patients who present with portal vein thrombosis (PVT) or Budd-Chiari Syndrome (BCS). METHODS: Nine patients with recent PVT and four patients with BCS underwent TIPS. The diagnosis was confirmed by color Doppler ultrasound and by angio gram in most patients. Patients were followed clinically and had TIPS check ed periodically for patency. The end point was mortality, subsequent surgic al shunting or orthotopic liver transplantation (OLT). RESULTS: TIPS was placed in 13 of 15 (87%) patients with BCS or PVT. The me an decrease in pressure gradient was 56%. Median and mean follow-up were 14 months and 16.9 months. Procedure related complications occurred in two of 13 (15%), both in the PVT group. Direct procedural mortality was one of 13 (8%). The majority of patients with PVT (five of eight) underwent OLT. Of the remaining three, one patient subsequently developed a cavernous transfo rmation of portal vein but is stable, one patient is stable, without furthe r variceal bleeding, and one patient died because of multiple organ failure . In patients with BCS, three of four (75%) did well with TIPS, but one pat ient required immediate surgical shunting after occlusion of the TIPS. Two patients underwent OLT and the fourth patient is stable 2 yr later but has cirrhosis on biopsy. CONCLUSIONS: In patients with BCS, TIPS placement is effective and can be u sed as a bridge to liver transplantation. TIPS in the noncavernous PVT grou p should only be recommended when cirrhosis and uncontrollable variceal ble eding are present. (Am J Gastroenterol 1999,94. 603-608. (C) 1999 by Am. Ce ll. of Gastroenterology).