Abstract
Twelve patients with the Budd-Chiari syndrome have been managed surgically. Ten of the patients were female, two were male, with a mean age of 40 years. Three of the patients had polycythemia vera, two had pre-existing cirrhosis, one had ingested estrogens, one had an occult tumor, and in four there were no associated factors. Ten patients presented with ascites and two with bleeding esophageal varices. The diagnosis was confirmed in all 12 patients by liver biopsy and hepatic vein catheterization. Inferior vena cavography revealed the abdominal vena cava to be thrombosed in six patients. The superior mesenteric vein was used to decompress the congested liver in all 12 patients. In five patients, a mesocaval shunt (MCS) was performed and in seven patients, a mesoatrial shunt (MAS) was carried out. There were four hospital deaths (two MCS, two MAS). One late death (MAS) occurred from liver failure following shunt thrombosis. Two additional patients (one MCS, one MAS) re-developed ascites immediately following surgery and angiography revealed a thrombosed shunt. Ascites has been controlled with a LeVeen shunt in these two patients, but liver biopsies showed progression to cirrhosis. The remaining five patients (three MAS, two MCS) did well, and angiography revealed patent shunts. Two of these patients, however, re-developed ascites at 4 and 10 months following MAS and required a second MAS. Follow-up ranges from 6 to 68 months. In three of the patients (two MCS, one MAS) with patent shunts, liver biopsy shows a remarkable return toward normal liver architecture and histology.
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- Akita H., Sakoda K. Portopulmonary shunt by splenopneumopexy as a surgical treatment of Budd-Chiari syndrome. Surgery. 1980 Jan;87(1):85–94. [PubMed] [Google Scholar]
- Calne R. Y., Williams R. Orthotopic liver transplantation: the first 60 patients. Br Med J. 1977 Feb 19;1(6059):471–476. doi: 10.1136/bmj.1.6059.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cameron J. L., Harrington D. P., Maddrey W. C. The mesocaval C shunt. Surg Gynecol Obstet. 1980 Mar;150(3):401–403. [PubMed] [Google Scholar]
- Cameron J. L., Maddrey W. C. Mesoatrial shunt: a new treatment for the Budd-Chiari syndrome. Ann Surg. 1978 Apr;187(4):402–406. doi: 10.1097/00000658-197804000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cassel G. A., Morley J. E. Hepatic vein thrombosis treated with streptokinase. S Afr Med J. 1974 Nov 16;48(56):2319–2320. [PubMed] [Google Scholar]
- Chapman J. E., Ochsner J. L. Iliac-mesenteric-atrial shunt procedure for Budd-Chiari syndrome complicated by inferior vena caval thrombosis. Ann Surg. 1978 Nov;188(5):642–646. doi: 10.1097/00000658-197811000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hirooka M., Kimura C. Membranous obstruction of the hepatic portion of the inferior vena cava. Surgical correction and etiological study. Arch Surg. 1970 Jun;100(6):656–663. doi: 10.1001/archsurg.1970.01340240024005. [DOI] [PubMed] [Google Scholar]
- Huguet C., Liegeois A., Levy V. G., Caroli J. Interposition mesocaval shunt for chronic primary occlusion of the hepatic veins. Surg Gynecol Obstet. 1979 May;148(5):691–698. [PubMed] [Google Scholar]
- Langer B., Stone R. M., Colapinto R. F., Meindok H., Phillips M. J., Fisher M. M. Clinical spectrum of the Budd-Chiari syndrome and its surgical management. Am J Surg. 1975 Feb;129(2):137–145. doi: 10.1016/0002-9610(75)90289-5. [DOI] [PubMed] [Google Scholar]
- LeVeen H. H., Wapnick S., Grosberg S., Kinney M. J. Further experience with peritoneo-venous shunt for ascites. Ann Surg. 1976 Nov;184(5):574–581. doi: 10.1097/00000658-197611000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mitchell M. C., Boitnott J. K., Kaufman S., Cameron J. L., Maddrey W. C. Budd-Chiari syndrome: etiology, diagnosis and management. Medicine (Baltimore) 1982 Jul;61(4):199–218. doi: 10.1097/00005792-198207000-00001. [DOI] [PubMed] [Google Scholar]
- Orloff M. J., Johansen K. H. Treatment of Budd-Chiari syndrome by side-to-side portacaval shunt: experimental and clinical results. Ann Surg. 1978 Oct;188(4):494–512. doi: 10.1097/00000658-197810000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- PARKER R. G. Occlusion of the hepatic veins in man. Medicine (Baltimore) 1959 Dec;38:369–402. doi: 10.1097/00005792-195912000-00002. [DOI] [PubMed] [Google Scholar]
- Putnam C. W., Porter K. A., Weil R., 3rd, Reid H. A., Starzl T. E. Liver transplantation of Budd-Chiari syndrome. JAMA. 1976 Sep 6;236(10):1142–1143. [PMC free article] [PubMed] [Google Scholar]
- Wruble L. D., Scott J. C., Wolf R. Y. Budd-Chiari syndrome: dramatic relief with mesoatrial shunt. Am J Gastroenterol. 1982 Apr;77(4):253–255. [PubMed] [Google Scholar]