Outcome of non surgical hepatic decompression procedures in Egyptian patients with Budd-Chiari

Table 1 Clinical manifestations and radiological criteria in studied patients

Findings	Patients, n (%)
Clinical manifestations
Abdominal pain	23 (92)
Jaundice	9 (36)
Lower limb edema	10 (40)
Dilated veins over abdomen and trunk	5 (20)
Tender hepatomegaly	16 (64)
Ascites	24 (96)
Radiological criteria
Hepatomegaly	24 (96)
Splenomegaly	22 (88)
Ascites
Absent	1 (4)
Present	24 (96)
Liver mottling appearance	17 (68)
Intra hepatic collaterals	16 (64)
Caudate lobe hypertrophy	12 (48)
Hepatic Veins:Short segment occlusion
RHV	2 (8)
MHV	7 (28)
LHV	5 (20)
Total occlusion
RHV	23 (92)
MHV	18 (72)
LHV	20 (80)

Radiological criteria were obtained using duplex ultrasound, magnetic resonance venography and/or multislice computed tomography scan. RHV: Right hepatic vein; MHV: Middle hepatic vein; LHV: Left hepatic vein.

Table 2 Details of patients who needed revisions and their follow up (n = 10)

Patient	Intervention	Time of dysfunction	Action taken	No of revisions	1 yr patency	End of FUP patency
23 yr F	Angioplasty without stenting	Day 7 and Day 10	TIPS was done, occluded at day 10; then re-angioplasty was done1	2	Patent	Patent at 20th mo
27 yr M	Angioplasty and stenting	Day 7 and 2nd yr	Angioplasty was done-then angioplasty + thrombectomy	2	Patent	Patent at 24th mo
28 yr F	Angioplasty and stenting	4th mo	Angioplasty + local thrombolytic therapy	1	Patent	Patent at 12th mo
30 yr F	Angioplasty and stenting	1st, 4th, 6th and 9th mo	TIPS was done-then angioplasty (3 times)	4	Occluded at 9th mo	Occluded at 24th mo
28 yr M	Angioplasty and stenting	3rd mo and 14th mo	Angioplasty + stent was done-then mesoatrial shunt	1	Occluded at 1 yr	Dead2 at 17th mo
27 yr F	TIPS	Day 1	(stent occlusion and migration to portal vein) - Re (TIPS)	1	Patent	Patent at 20th m
33 yr F	TIPS	Day 3	Angioplasty + thrombectomy + systemic thrombolytic therapy	1	Patent	Patent at 32nd mo
37 yr F	TIPS	Day 7 and 1st mo	Angioplasty (2 times)	2	Patent	Patent at 12th mo
27 yr M	TIPS	Day 7, 3rd and 8th mo	Angioplasty (3 times)	3	Patent	Occluded at 20th mo
17 yr M	TIPS	1st mo	Patient refused intervention	0	Occluded	Occluded at 12th mo

¹Patient had angioplasty dysfunction at Day 7, so transjugular intrahepatic portosystemic shunt (TIPS) was done but was occluded at Day 10, so angioplasty of TIPS stent was done;

²Cause of death: Intraperitoneal bleeding. Follow up period: Minimum (12 mo), Maximum (32 mo). F: Female; M: Male; yr: Years old; FUP: Follow up.

Table 3 Patient survival n (%)

	Angioplasty	TIPS	Total
One year
Alive	12 (100)	13 (100)	25 (100)
Dead	0 (0)	0 (0)	0 (0)
End of follow up
Alive	11 (91.6)	13 (100)	24 (96)
Dead	1 (8.4)	0 (0)	1 (4)

Because of death of one patient only out of 25; Kaplan–Meier curve couldn’t be drawn for patient survival. TIPS: Transjugular intrahepatic portosystemic shunt.

Table 4 Clinical data of patients before and after intervention

	Before intervention		One year after intervention		P value	Sig
	+VE	-VE	+VE	-VE
Patients with occluded shunts (n = 3)
Abdominal pain	3	0	2	1	> 0.05	NS
Jaundice	1	2	0	3	> 0.05	NS
Lower limb edema	2	1	1	2	> 0.05	NS
Dilated veins	1	2	0	3	> 0.05	NS
Ascites	3	0	3	0	> 0.05	NS
Patients with patent shunts (n = 22)
Abdominal pain	20	2	1	21	< 0.001	VHS
Jaundice	8	14	0	22	< 0.01	HS
Lower limb edema	8	14	1	21	< 0.05	S
Dilated veins	4	18	0	22	> 0.05	NS
Ascites	21	1	1	21	< 0.001	VHS

Sig: Significance; NS: Non significant; S: Significant; HS: Highly significant; VHS: Very highly significant; -VE: Negative; +VE: Positive.

Table 5 Lab data and performance status of patients before and after intervention

	Before intervention		One year after intervention		P value	Sig
	mean	SD	mean	SD
Patients with occluded shunts (n = 3)
ALT (N = 7-40 IU/L)	70.33	75.070	29.66	24.66	> 0.05	NS
AST (N = 7-37 IU/L)	42	24.240	42.33	32.51	> 0.05	NS
Total bilirubin (N = 0.2-1.2 mg/dL)	2.9	2.940	1.26	0.832	> 0.05	NS
Direct bilirubin (N = 0-0.3 mg/dL)	1.53	1.560	0.53	0.577	> 0.05	NS
Albumin (N = 3.5-5.3 g/dL)	3.7	0.800	3.56	0.901	> 0.05	NS
Performance status	3.33	0.577	2.00	1.730	> 0.05	NS
Patients with patent shunts (n = 22)
ALT (N = 7-40 IU/L)	66.95	117.265	26.45	8.528	< 0.05	S
AST (N = 7-37 IU/L)	53.95	33.832	32.22	9.586	< 0.01	HS
Total bilirubin (N = 0.2-1.2 mg/dL)	2.818	3.198	1.21	0.414	< 0.01	HS
Direct bilirubin (N = 0-0.3 mg/dL)	1.29	2.022	0.51	0.296	< 0.01	HS
Albumin (N = 3.5-5.3 g/dL)	3.5	0.475	3.93	0.576	< 0.01	HS
Performance status	2.59	1.007	0.18	0.664	< 0.001	VHS

N: Normal range; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Sig: Significance; NS: Non significant; S: Significant; HS: Highly significant; VHS: Very highly significant.

Table 6 Comparison of different transjugular intrahepatic portosystemic shunt studies in Budd-Chiari syndrome with the current study

Points of comparison	Mancuso et al[18]	Perelló et al[19]	Rössle et al[20]	Hernández-Guerra et al[21]	Current study
No. of patients	15	13	35	25 (9 covered stents)	13
Mean age in years (range)	40 (20-73)	36 (17-67)	43 (12-74)	40 (17-54)	29 (14-57)
Median child score	11	9	9	9	8
Acute, fulminant/chronic presentation	8/6	4/6	11/13	ND	2/11
Mean follow-up (mo)	24	48	37	20	18
Stent stenosis (%)	36	72	47	67 (19% covered stents)	38.4
Anticoagulation (%)	100	95	100	ND	100
Patients with acute presentation who died	4	ND	2	ND	0
Patients with chronic presentation who died	0	ND	1	ND	0
Death total (%)	30	10	9	0	0
Liver transplantation	0	1	2	0	0
Surgical portocaval shunt	0	2	0	0	0

ND: Not determined; Anticoagulation: Percent of patients who were adherent to anticoagulation therapy.