Repeat interventions for maintenance of transjugular intrahepatic portosystemic shunt function in patients with Budd-Chiari syndrome.

The authors report the role of transjugular intrahepatic portosystemic shunts (TIPS) and consecutive interventions, including brachytherapy (n = 2) and stent-graft placement (n = 3), to increase secondary patency and consequently postpone orthotopic liver transplantation (OLT) in the treatment of Budd-Chiari syndrome in eight patients. Two patients (with hematologic diseases) died 2 weeks after the TIPS procedure. Median follow-up in the six survivors was 42.5 months (range, 11-79 mo). Multiple TIPS occlusions occurred in three patients (range, 2-7 revisions). Reocclusions occurred despite brachytherapy and Hemobahn stent-graft placement and necessitated OLT in one patient. Revision-free patency was achieved in the other two patients after VIATORR stent-graft placement (16 and 32 months after TIPS creation). All patients with stable TIPS (n = 5) are without ascites, no liver failure occurred, and no patients are currently on the transplant list.