Indications and prognosis of transjugular intrahepatic portosystemic shunt in patients with primary Budd-Chiari syndrome_West China Medical Journal

Authors：

SONG Jinlei , WANG Xiaoze , YANG Li ,  LUO Xuefeng

Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUO Xuefeng, Email: luo_xuefeng@yeah.net

Keywords：

Transjugular intrahepatic portosystemic shunt; Budd-Chiari syndrome; indications; prognosis

DOI：

10.7507/1002-0179.202107270

Video：

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Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). Methods Patients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.

Citation： SONG Jinlei, WANG Xiaoze, YANG Li, LUO Xuefeng. Indications and prognosis of transjugular intrahepatic portosystemic shunt in patients with primary Budd-Chiari syndrome. West China Medical Journal, 2022, 37(4): 542-549. doi: 10.7507/1002-0179.202107270 Copy

1.	DeLeve LD, Valla DC, Garcia-Tsao G, et al. Vascular disorders of the liver. Hepatology, 2009, 49(5): 1729-1764.
2.	Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology, 2013, 57(5): 1962-1968.
3.	Hayek G, Ronot M, Plessier A, et al. Long-term outcome and analysis of dysfunction of transjugular intrahepatic portosystemic shunt placement in chronic primary Budd-Chiari syndrome. Radiology, 2017, 283(1): 280-292.
4.	Mancuso A. Budd-Chiari syndrome in the west and the east: same syndrome, different diseases. Liver Int, 2019, 39(12): 2417.
5.	Shukla A, Shreshtha A, Mukund A, et al. Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int, 2021, 15(3): 531-567.
6.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
7.	Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
8.	Darwish Murad S, Valla DC, de Groen PC, et al. Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome. Hepatology, 2004, 39(2): 500-508.
9.	Garcia-Pagán JC, Heydtmann M, Raffa S, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology, 2008, 135(3): 808-815.
10.	中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员会. 布-加综合征亚型分型的专家共识. 介入放射学杂志, 2017, 26(3): 195-201.
11.	Zhang X, Wang SZ, Zheng JF, et al. Clinical efficacy of tolvaptan for treatment of refractory ascites in liver cirrhosis patients. World J Gastroenterol, 2014, 20(32): 11400-11405.
12.	Qi X, Guo W, He C, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: techniques, indications and results on 51 Chinese patients from a single centre. Liver Int, 2014, 34(8): 1164-1175.
13.	中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南(2017, 北京). 中华胃肠内镜电子杂志, 2018, 5(1): 1-17.
14.	Hemachandran N, Shalimar, Acharya S, et al. Long-term outcomes of endovascular interventions in more than 500 patients with Budd-Chiari syndrome. J Vasc Interv Radiol, 2021, 32(1): 61-69e61.
15.	Luo X, Zhao M, Wang X, et al. Long-term patency and clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft. PLoS One, 2019, 14(2): e0212658.
16.	Zhang W, Wang QZ, Chen XW, et al. Budd-Chiari syndrome in China: a 30-year retrospective study on survival from a single center. World J Gastroenterol, 2018, 24(10): 1134-1143.
17.	Inchingolo R, Posa A, Mariappan M, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: a comprehensive review. World J Gastroenterol, 2020, 26(34): 5060-5073.
18.	单航声, 蒋明明, 徐浩, 等. 改良经颈静脉肝内门体分流术治疗布-加综合征所致顽固性腹水效果分析. 介入放射学杂志, 2021, 30(3): 235-238.
19.	Mancuso A. An update on the management of Budd-Chiari syndrome: the issues of timing and choice of treatment. Eur J Gastroenterol Hepatol, 2015, 27(3): 200-203.
20.	Mancuso A. Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: an Italian hepatologist’s perspective. J Transl Int Med, 2017, 5(4): 194-199.
21.	Horhat A, Bureau C, Thabut D, et al. Transjugular intrahepatic portosystemic shunt in patients with cirrhosis: indications and posttransjugular intrahepatic portosystemic shunt complications in 2020. United European Gastroenterol J, 2020, 9(2): 203-208.
22.	Khan F, Mehrzad H, Tripathi D. Timing of transjugular intrahepatic portosystemic stent-shunt in Budd-Chiari syndrome: A UK hepatologist’s perspective. J Transl Int Med, 2018, 6(3): 97-104.
23.	He FL, Wang L, Zhao HW, et al. Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome. World J Gastroenterol, 2015, 21(8): 2413-2418.
24.	He F, Zhao H, Dai S, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome with diffuse occlusion of hepatic veins. Sci Rep, 2016, 6: 36380.
25.	Qi X, Yang M, Fan D, et al. Transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome: a critical review of literatures. Scand J Gastroenterol, 2013, 48(7): 771-784.
26.	Valla DC. Budd-Chiari syndrome/hepatic venous outflow tract obstruction. Hepatol Int, 2018, 12(Suppl 1): 168-180.
27.	Hernández-Guerra M, Turnes J, Rubinstein P, et al. PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome. Hepatology, 2004, 40(5): 1197-1202.

1. DeLeve LD, Valla DC, Garcia-Tsao G, et al. Vascular disorders of the liver. Hepatology, 2009, 49(5): 1729-1764.
2. Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology, 2013, 57(5): 1962-1968.
3. Hayek G, Ronot M, Plessier A, et al. Long-term outcome and analysis of dysfunction of transjugular intrahepatic portosystemic shunt placement in chronic primary Budd-Chiari syndrome. Radiology, 2017, 283(1): 280-292.
4. Mancuso A. Budd-Chiari syndrome in the west and the east: same syndrome, different diseases. Liver Int, 2019, 39(12): 2417.
5. Shukla A, Shreshtha A, Mukund A, et al. Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int, 2021, 15(3): 531-567.
6. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
7. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
8. Darwish Murad S, Valla DC, de Groen PC, et al. Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome. Hepatology, 2004, 39(2): 500-508.
9. Garcia-Pagán JC, Heydtmann M, Raffa S, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology, 2008, 135(3): 808-815.
10. 中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员会. 布-加综合征亚型分型的专家共识. 介入放射学杂志, 2017, 26(3): 195-201.
11. Zhang X, Wang SZ, Zheng JF, et al. Clinical efficacy of tolvaptan for treatment of refractory ascites in liver cirrhosis patients. World J Gastroenterol, 2014, 20(32): 11400-11405.
12. Qi X, Guo W, He C, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: techniques, indications and results on 51 Chinese patients from a single centre. Liver Int, 2014, 34(8): 1164-1175.
13. 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南(2017, 北京). 中华胃肠内镜电子杂志, 2018, 5(1): 1-17.
14. Hemachandran N, Shalimar, Acharya S, et al. Long-term outcomes of endovascular interventions in more than 500 patients with Budd-Chiari syndrome. J Vasc Interv Radiol, 2021, 32(1): 61-69e61.
15. Luo X, Zhao M, Wang X, et al. Long-term patency and clinical outcome of the transjugular intrahepatic portosystemic shunt using the expanded polytetrafluoroethylene stent-graft. PLoS One, 2019, 14(2): e0212658.
16. Zhang W, Wang QZ, Chen XW, et al. Budd-Chiari syndrome in China: a 30-year retrospective study on survival from a single center. World J Gastroenterol, 2018, 24(10): 1134-1143.
17. Inchingolo R, Posa A, Mariappan M, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: a comprehensive review. World J Gastroenterol, 2020, 26(34): 5060-5073.
18. 单航声, 蒋明明, 徐浩, 等. 改良经颈静脉肝内门体分流术治疗布-加综合征所致顽固性腹水效果分析. 介入放射学杂志, 2021, 30(3): 235-238.
19. Mancuso A. An update on the management of Budd-Chiari syndrome: the issues of timing and choice of treatment. Eur J Gastroenterol Hepatol, 2015, 27(3): 200-203.
20. Mancuso A. Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: an Italian hepatologist’s perspective. J Transl Int Med, 2017, 5(4): 194-199.
21. Horhat A, Bureau C, Thabut D, et al. Transjugular intrahepatic portosystemic shunt in patients with cirrhosis: indications and posttransjugular intrahepatic portosystemic shunt complications in 2020. United European Gastroenterol J, 2020, 9(2): 203-208.
22. Khan F, Mehrzad H, Tripathi D. Timing of transjugular intrahepatic portosystemic stent-shunt in Budd-Chiari syndrome: A UK hepatologist’s perspective. J Transl Int Med, 2018, 6(3): 97-104.
23. He FL, Wang L, Zhao HW, et al. Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome. World J Gastroenterol, 2015, 21(8): 2413-2418.
24. He F, Zhao H, Dai S, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome with diffuse occlusion of hepatic veins. Sci Rep, 2016, 6: 36380.
25. Qi X, Yang M, Fan D, et al. Transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome: a critical review of literatures. Scand J Gastroenterol, 2013, 48(7): 771-784.
26. Valla DC. Budd-Chiari syndrome/hepatic venous outflow tract obstruction. Hepatol Int, 2018, 12(Suppl 1): 168-180.
27. Hernández-Guerra M, Turnes J, Rubinstein P, et al. PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome. Hepatology, 2004, 40(5): 1197-1202.

West China Medical Journal

Indications and prognosis of transjugular intrahepatic portosystemic shunt in patients with primary Budd-Chiari syndrome

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