Treatment of Budd-Chiari syndrome with occlusion of both inferior vena cava and hepatic veins lesions by interposition of graft meso-caval-atrial shunt

Abstract

To evaluate the therapeutic efficacy of interposition of graft meso-cavo-atri shunt (MCAS) for the treatment of Budd-Chiari syndrome (BCS) with occlusion of both inferior cava vena (ICV) and hepatic veins (HVs). 51 BCS patients with combined occlusion of ICV and HVs, 30 males and 20 females, aged 18-45, underwent MCAS. A 16-18 mm ring-reinforced graft (main graft) was anastomosed firstly to the side of ICV with continuous 5/0 vascular suture, then to the side of the right atrium with continuous 5/0 vascular suture. A 10-12 mm graft (secondary graft) was anastomosed to the side of the superior mesenteric vein (SMV) with continuous 5/0 vascular suture, then to the side of the main graft with continuous 5/0 vascular suture. The pressure and blood flow of ICV and portal vein (PV) were examined before and after operation. The patients were followed up for 6 months to 16 years. There was no perioperative death. During the follow-up no thrombosis of the main graft was found but thrombosis of the secondary graft occurred in two cases. The patency rates of the main and secondary grafts were 100% and 96.1% respectively. The total patency rate of graft was 96.1%. After operation the pressure of IVC and PV decreased by 17.4 +/- 5.7 cm HO2O and 17.0 +/- 7.0 cm H2O respectively compared with those before operation. MCAS is very effective in decompression of PC and IVC. MCAS may be a valuable surgical procedure for treatment of BCS with occlusion of both ICV and HVs.