Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2413-2418
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2413
Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu
Fu-Liang He, Lei Wang, Hong-Wei Zhao, Zhen-Hua Fan, Meng-Fei Zhao, Shan Dai, Zhen-Dong Yue, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Liu FQ designed the research; He FL, Wang L, Zhao HW and Yue ZD performed the research; Zhao MF and Dai S contributed new reagents and analytical tools; Fan ZH analyzed the data; He FL wrote the paper.
Ethics approval: The study was reviewed and approved by the Beijing Shijitan Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no potential conflict of interests.
Data sharing: Technical appendix, statistical code and dataset are available from the corresponding author at liufq_sjt@163.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fu-Quan Liu, MD, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing 100038, China. liufq_sjt@163.com
Telephone: +86-10-63926269 Fax: +86-10-63926325.
Received: October 17, 2014
Peer-review started: October 17, 2014
First decision: November 14, 2014
Revised: December 18, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: February 28, 2015
Abstract

AIM: To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) for severe jaundice secondary to acute Budd-Chiari syndrome (BCS).

METHODS: From February 2009 to March 2013, 37 patients with severe jaundice secondary to acute BCS were treated. Sixteen patients without hepatic venule, hepatic veins (HV) obstruction underwent percutaneous angioplasty of the inferior vena cava (IVC) and/or HVs. Twenty-one patients with HV occlusion underwent TIPS. Serum bilirubin, liver function, demographic data and operative data of the two groups of patients were analyzed.

RESULTS: Twenty-one patients underwent TIPS and the technical success rate was 100%, with no technical complications. Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%. The mean procedure time for TIPS was 84.0 ± 12.11 min and angioplasty was 44.11 ± 5.12 min (P < 0.01). The mean portosystemic pressure in the TIPS group decreased significantly from 40.50 ± 4.32 to 16.05 ± 3.50 mmHg (P < 0.01). The mean portosystemic pressure gradient decreased significantly from 33.60 ± 2.62 to 7.30 ± 2.21 mmHg (P < 0.01). At 8 wk after the procedures, in the TIPS group, total bilirubin (TBIL) decreased significantly from 266.24 ± 122.03 before surgery to 40.11 ± 3.52 μmol/L (P < 0.01) and direct bilirubin (DBIL) decreased significantly from 194.22 ± 69.82 μmol/L to 29.82 ± 3.10 μmol/L (P < 0.01). In the angioplasty group, bilirubin returned to the normal range, with TBIL decreased significantly from 258.22 ± 72.71 μmol/L to 13.33 ± 3.54 μmol/L (P < 0.01) and DBIL from 175.08 ± 39.27 to 4.03 ± 1.74 μmol/L (P < 0.01). Liver function improved faster than TBIL. After 2 wk, in the TIPS group, alanine aminotransferase (ALT) decreased significantly from 50.33 ± 40.61 U/L to 28.67 ± 7.02 U/L (P < 0.01) and aspartate aminotransferase (AST) from 49.46 ± 34.33 U/L to 26.89 ± 8.68 U/L (P < 0.01). In the angioplasty group, ALT decreased significantly from 51.56 ± 27.90 to 14.22 ± 2.59 μmol/L (P < 0.01) and AST from 60.66 ± 39.89 μmol/L to 8.18 ± 1.89 μmol/L (P < 0.01). After mean follow-up of 12.6 mo, there was no recurrence of jaundice in either group.

CONCLUSION: Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.

Keywords: Budd-Chiari syndrome, Jaundice, Transjugular intrahepatic portosystemic shunt, Interventional therapy, Percutaneous angioplasty

Core tip: Jaundice with bilirubin > 51.3 μmol/L (3 mg/dL) is a contraindication for transjugular intrahepatic portosystemic shunt (TIPS) in patients with liver cirrhosis or end-stage liver disease. However, 21 patients in our single center underwent TIPS due to severe jaundice secondary to acute Budd-Chiari syndrome (BCS) and good clinical outcomes were achieved. We present a single center clinical experience and discuss the feasibility and effectiveness of treating severe jaundice secondary to acute BCS with TIPS.