The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts

J. L. Cameron, H. F. Herlong, H. Sanfey, J. Boitnott, S. L. Kaufman, V. L. Gott, W. C. Maddrey

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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) redeveloped 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, red 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.

Original languageEnglish (US)
Pages (from-to)335-346
Number of pages12
JournalAnnals of Surgery
Volume198
Issue number3
StatePublished - 1983

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Budd-Chiari Syndrome
Ascites
Therapeutics
Liver
Thrombosis
Biopsy
Angiography
Fibrosis
Peritoneovenous Shunt
Mesenteric Veins
Polycythemia Vera
Venae Cavae
Hepatic Veins
Esophageal and Gastric Varices
Liver Failure
Catheterization

ASJC Scopus subject areas

  • Surgery

Cite this

Cameron, J. L., Herlong, H. F., Sanfey, H., Boitnott, J., Kaufman, S. L., Gott, V. L., & Maddrey, W. C. (1983). The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts. Annals of Surgery, 198(3), 335-346.

The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts. / Cameron, J. L.; Herlong, H. F.; Sanfey, H.; Boitnott, J.; Kaufman, S. L.; Gott, V. L.; Maddrey, W. C.

In: Annals of Surgery, Vol. 198, No. 3, 1983, p. 335-346.

Research output: Contribution to journalArticle

Cameron, JL, Herlong, HF, Sanfey, H, Boitnott, J, Kaufman, SL, Gott, VL & Maddrey, WC 1983, 'The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts', Annals of Surgery, vol. 198, no. 3, pp. 335-346.
Cameron JL, Herlong HF, Sanfey H, Boitnott J, Kaufman SL, Gott VL et al. The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts. Annals of Surgery. 1983;198(3):335-346.
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. In: Annals of Surgery. 1983 ; Vol. 198, No. 3. pp. 335-346.
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