Direct intrahepatic portocaval shunt for treatment of portal thrombosis and Budd-Chiari syndrome

Mark R. Pedersen, Peter Molloy, David Wood, Anil Seetharam

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Budd-Chiari syndrome (BCS) refers to hepatic venous outflow obstruction that in severe cases can lead to acute liver failure prompting consideration of revascularization or transplantation. Here, a 22 year old female with angiographically proven BCS secondary to JAK2/V617F positive Polycythemia vera on therapeutic warfarin presented with acute liver failure (ALF). Imaging revealed a new, near complete thrombotic occlusion of the main portal vein with extension into the superior mesenteric vein. An emergent direct intrahepatic portocaval shunt (DIPS) was created and liver function promptly normalized. She has been maintained on rivaroxaban since that time. Serial assessment over 1 year demonstrated continued shunt patency and improved flow in the mesenteric vasculature on ultrasound as well as normal liver function. DIPS is a viable alternative in the treatment of ALF from BCS when standard recanalization is not feasible. Improved blood flow may also improve portal/mesenteric clot burden. While further investigation is needed, new targeted anticoagulants may be viable as a long term anticoagulation strategy.

Original languageEnglish (US)
Pages (from-to)127-130
Number of pages4
JournalAnnals of Hepatology
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • Acute liver failure
  • BCS
  • DIPS
  • Hepatic vein thrombosis

ASJC Scopus subject areas

  • Hepatology

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