Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Budd-Chiari Syndrome (BCS): Experience at a Tertiary Health Center

Abstract

Purpose: Transjugular intrahepatic portosystemic shunt (TIPS) is a technically challenging but efficient therapeutic tool in patients with Budd-Chiari syndrome (BCS). Results from several small series appear promising but long-term outcome is not well studied. We aimed to analyze the results of TIPS as a treatment option in BCS and and compare the outcome of PTFE-covered stents vs bare stents. Methods: Of 148 patients of Budd-Chiari syndrome, 115 underwent vascular interventions. 17 patients underwent TIPS/ modified TIPS. Patients were followed 3–6 monthly with clinical and biochemical assessment, color doppler and; venography yearly. Results: 17/18 (94.4%, male-12, median age 30 ± 11.7) patients underwent successful procedure. Median duration of symptoms to diagnosis was 3 months. Presentation was acute, subacute and chronic in 4, 6 and 7 cases, respectively. Indications were ascites (15/17) and variceal bleed (2/17) which were controlled in all. Ten and 7 received PTFE covered and bare stents respectively. In addition to hepatic vein occlusion, 3 had IVC block for which IVC stenting was done. Total follow up period was 21 months (range 1–52 m). Five stent dysfunctions and repeat interventions were required in 4 patients with uncovered stents (median 22 months range 2–55 months) vs 2/10 with PTFE-covered stents (median 18 months range 1–34 m) (P= 0.0339). One year actuarial primary patency rates were 80% vs 57.5% in PTFE-covered stent group vs uncovered stent group. There were 2 deaths; 1 patient developed intraperitoneal bleed and died 30 days later and the other patient died 4 months later because of variceal bleed and complications precipitated by TIPS dysfunction. Conclusion: TIPS is a useful modality of treatment for BCS with nonrecanalizable hepatic veins. PTFE Covered stents may be better than uncovered stents.