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. 1991 Nov;214(5):581–589. doi: 10.1097/00000658-199111000-00008

Portasystemic shunting versus liver transplantation for the Budd-Chiari syndrome.

H Bismuth 1, D J Sherlock 1
PMCID: PMC1358614  PMID: 1953111

Abstract

Over 12 years, 22 patients with the Budd-Chiari syndrome were treated surgically. Eighteen underwent a mesenterico-caval shunt (MCS); two, a side-to-side portacaval shunt; one, a mesenterico-atrial shunt (MAS); and one, a liver transplantation (OLT). One patient died after operation from the precipitating condition, and two MCS grafts that thrombosed were restored. All 21 surviving patients remain well, free from ascites, and all shunts are patent after a mean follow-up of 5.6 +/- 1 years, five patients with more than 10 years' follow-up. This long-term survival achieved by portasystemic shunts suggests that they have a major role in the treatment of the Budd-Chiari syndrome. The authors prefer the mesenterico-caval shunt using a jugular graft. This ensures a total portasystemic shunt, avoids subhepatic surgery, and reduces the long-term risk of prosthetic graft thrombosis. The MAS was reserved for cases with complete caval thrombosis. Patients with significant degrees of caval compression were satisfactorily decompressed by MCS. In patients not promptly treated, the disease progresses to cirrhosis, and such patients must be evaluated for transplantation similarly to those with other hepatopathies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahn S. S., Yellin A., Sheng F. C., Colonna J. O., Goldstein L. I., Busuttil R. W. Selective surgical therapy of the Budd-Chiari syndrome provides superior survivor rates than conservative medical management. J Vasc Surg. 1987 Jan;5(1):28–37. [PubMed] [Google Scholar]
  2. BRAS G., JELLIFFE D. B., STUART K. L. Veno-occlusive disease of liver with nonportal type of cirrhosis, occurring in Jamaica. AMA Arch Pathol. 1954 Apr;57(4):285–300. [PubMed] [Google Scholar]
  3. Bismuth H., Adam R., Mathur S., Sherlock D. Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era. Am J Surg. 1990 Jul;160(1):105–110. doi: 10.1016/s0002-9610(05)80878-5. [DOI] [PubMed] [Google Scholar]
  4. Bismuth H., Franco D., Hepp J. Portal-systemic shunt in hepatic cirrhosis: does the type of shunt decisively influence the clinical result? Ann Surg. 1974 Feb;179(2):209–218. doi: 10.1097/00000658-197402000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bismuth H. Liver transplantation: the Paul Brousse experience. Transplant Proc. 1988 Feb;20(1 Suppl 1):486–489. [PubMed] [Google Scholar]
  6. 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]
  7. Cameron J. L., Herlong H. F., Sanfey H., Boitnott J., Kaufman S. L., Gott V. L., Maddrey W. C. The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts. Ann Surg. 1983 Sep;198(3):335–346. doi: 10.1097/00000658-198309000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Campbell D. A., Jr, Rolles K., Jamieson N., O'Grady J., Wight D., Williams R., Calne R. Hepatic transplantation with perioperative and long term anticoagulation as treatment for Budd-Chiari syndrome. Surg Gynecol Obstet. 1988 Jun;166(6):511–518. [PubMed] [Google Scholar]
  10. Drapanas T. Interposition mesocaval shunt for treatment of portal hypertension. Ann Surg. 1972 Oct;176(4):435–448. doi: 10.1097/00000658-197210000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. GORE D. O., STUART K. L., BRAS G. Veno-occlusive disease of the liver: surgical aspects. Surgery. 1961 Mar;49:334–346. [PubMed] [Google Scholar]
  12. Halff G., Todo S., Tzakis A. G., Gordon R. D., Starzl T. E. Liver transplantation for the Budd-Chiari syndrome. Ann Surg. 1990 Jan;211(1):43–49. doi: 10.1097/00000658-199001000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. 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]
  14. Klein A. S., Cameron J. L. Diagnosis and management of the Budd-Chiari syndrome. Am J Surg. 1990 Jul;160(1):128–133. doi: 10.1016/s0002-9610(05)80882-7. [DOI] [PubMed] [Google Scholar]
  15. Lord J. W., Jr, Rossi G., Daliana M., Rosati L. M. Mesocaval shunt modified by the use of a teflon prosthesis. Surg Gynecol Obstet. 1970 Mar;130(3):525–526. [PubMed] [Google Scholar]
  16. McCarthy P. M., van Heerden J. A., Adson M. A., Schafer L. W., Wiesner R. H. The Budd-Chiari syndrome. Medical and surgical management of 30 patients. Arch Surg. 1985 Jun;120(6):657–662. doi: 10.1001/archsurg.1985.01390300007001. [DOI] [PubMed] [Google Scholar]
  17. McDermott W. V., Stone M. D., Bothe A., Jr, Trey C. Budd-Chiari syndrome. Historical and clinical review with an analysis of surgical corrective procedures. Am J Surg. 1984 Apr;147(4):463–467. doi: 10.1016/0002-9610(84)90006-0. [DOI] [PubMed] [Google Scholar]
  18. McDonald G. B., Sharma P., Matthews D. E., Shulman H. M., Thomas E. D. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology. 1984 Jan-Feb;4(1):116–122. doi: 10.1002/hep.1840040121. [DOI] [PubMed] [Google Scholar]
  19. Millikan W. J., Jr, Henderson J. M., Sewell C. W., Guyton R. A., Potts J. R., 3rd, Cranford C. A., Jr, Cramer A. R., Galambos J. T., Warren W. D. Approach to the spectrum of Budd-Chiari syndrome: which patients require portal decompression? Am J Surg. 1985 Jan;149(1):167–176. doi: 10.1016/s0002-9610(85)80028-3. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Orloff M. J., Girard B. Long term results of treatment of Budd-Chiari syndrome by side to side portacaval shunt. Surg Gynecol Obstet. 1989 Jan;168(1):33–41. [PubMed] [Google Scholar]
  22. 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]
  23. 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]
  24. Pezzuoli G., Spina G. P., Opocher E., Galeotti F., Zannini P. Portacaval shunt in the treatment of primary Budd-Chiari syndrome. Surgery. 1985 Aug;98(2):319–323. [PubMed] [Google Scholar]
  25. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  26. 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]
  27. Read R. C., Thompson B. W., Wise W. S., Murphy M. L. Mesocaval H venous homografts. Arch Surg. 1970 Dec;101(6):785–791. doi: 10.1001/archsurg.1970.01340300141024. [DOI] [PubMed] [Google Scholar]
  28. Stringer M. D., Howard E. R., Green D. W., Karani J., Gimson A. S., Williams R. Mesoatrial shunt: a surgical option in the management of the Budd-Chiari syndrome. Br J Surg. 1989 May;76(5):474–478. doi: 10.1002/bjs.1800760516. [DOI] [PubMed] [Google Scholar]
  29. Tavill A. S., Wood E. J., Kreel L., Jones E. A., Gregory M., Sherlock S. The Budd-Chiari syndrome: correlation between hepatic scintigraphy and the clinical, radiological, and pathological findings in nineteen cases of hepatic venous outflow obstruction. Gastroenterology. 1975 Mar;68(3):509–518. [PubMed] [Google Scholar]
  30. Terpstra O. T., Ausema B., Bruining H. A., Laméris J. S., Reuvers C. B., Schalm S. W., van Urk H., Wilson J. H. Late results of mesocaval interposition shunting for bleeding oesophageal varices. Br J Surg. 1987 Sep;74(9):787–790. doi: 10.1002/bjs.1800740911. [DOI] [PubMed] [Google Scholar]
  31. Van Steenbergen W., Beyls J., Vermylen J., Fevery J., Marchal G., Desmet V., De Groote J. 'Lupus' anticoagulant and thrombosis of the hepatic veins (Budd-Chiari syndrome). Report of three patients and review of the literature. J Hepatol. 1986;3(1):87–94. doi: 10.1016/s0168-8278(86)80151-9. [DOI] [PubMed] [Google Scholar]
  32. Wang Z. G., Zhu Y., Wang S. H., Pu L. P., Du Y. H., Zhang H., Yuan C., Chen Z., Wei M. L., Pu L. Q. Recognition and management of Budd-Chiari syndrome: report of one hundred cases. J Vasc Surg. 1989 Aug;10(2):149–156. [PubMed] [Google Scholar]

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