Acute Budd-Chiari Syndrome with Complete Portal Vein Thrombosis Complicated by Hepato-Renal Syndrome Treated Successfully by Emergent TIPS with Rheolytic Thrombectomy

We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with antico...

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Veröffentlicht in:	Journal of clinical and experimental hepatology Jg. 13; H. 3; S. 549 - 551
Hauptverfasser:	Michieletti, Emanuele, Bodini, Flavio C., Morelli, Nicola, Rossi, Beatrice, Bossalini, Margherita, Colombi, Davide
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	India Elsevier B.V 01.05.2023 Elsevier
Schlagworte:	Budd-Chiari syndrome Hepatorenal Letter to the Editor Syndrome Transjugular intrahepatic portosystemic shunt PTFE HRS CECT INR Transjugular intrahepatic portosystemic shunt Syndrome HV PVT PSS Budd-Chiari syndrome BCS IVC Hepatorenal TIPS
ISSN:	0973-6883, 2213-3453
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Abstract	We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with anticoagulants, a sudden impairment of the renal function requiring hemodialysis was observed. The hepatic transplant was excluded for patient age and clinical conditions. Thus, the patient was successfully treated by emergent transjugular intrahepatic portosystemic shunt (TIPS) previous rheolytic thrombectomy of the PVT with AngioJet Ultra PE Thrombectomy System (Boston Scientific, Marlborough, MA, USA). After the procedure, the sudden resolution of the HRS was observed, and the patient is alive 13 months after hospital dismission with no TIPS dysfunction. In conclusion, emergent extended TIPS with the usage of rheolytic thrombectomy device in patient with acute BCS-PVT complicated by HRS is feasible by experienced operators and provide resolution of the HRS.
AbstractList	We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with anticoagulants, a sudden impairment of the renal function requiring hemodialysis was observed. The hepatic transplant was excluded for patient age and clinical conditions. Thus, the patient was successfully treated by emergent transjugular intrahepatic portosystemic shunt (TIPS) previous rheolytic thrombectomy of the PVT with AngioJet Ultra PE Thrombectomy System (Boston Scientific, Marlborough, MA, USA). After the procedure, the sudden resolution of the HRS was observed, and the patient is alive 13 months after hospital dismission with no TIPS dysfunction. In conclusion, emergent extended TIPS with the usage of rheolytic thrombectomy device in patient with acute BCS-PVT complicated by HRS is feasible by experienced operators and provide resolution of the HRS. We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with anticoagulants, a sudden impairment of the renal function requiring hemodialysis was observed. The hepatic transplant was excluded for patient age and clinical conditions. Thus, the patient was successfully treated by emergent transjugular intrahepatic portosystemic shunt (TIPS) previous rheolytic thrombectomy of the PVT with AngioJet Ultra PE Thrombectomy System (Boston Scientific, Marlborough, MA, USA). After the procedure, the sudden resolution of the HRS was observed, and the patient is alive 13 months after hospital dismission with no TIPS dysfunction. In conclusion, emergent extended TIPS with the usage of rheolytic thrombectomy device in patient with acute BCS-PVT complicated by HRS is feasible by experienced operators and provide resolution of the HRS.We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with anticoagulants, a sudden impairment of the renal function requiring hemodialysis was observed. The hepatic transplant was excluded for patient age and clinical conditions. Thus, the patient was successfully treated by emergent transjugular intrahepatic portosystemic shunt (TIPS) previous rheolytic thrombectomy of the PVT with AngioJet Ultra PE Thrombectomy System (Boston Scientific, Marlborough, MA, USA). After the procedure, the sudden resolution of the HRS was observed, and the patient is alive 13 months after hospital dismission with no TIPS dysfunction. In conclusion, emergent extended TIPS with the usage of rheolytic thrombectomy device in patient with acute BCS-PVT complicated by HRS is feasible by experienced operators and provide resolution of the HRS. We described a case of a 73-year-old female admitted to the emergency department with acute hepatic and renal failure (hepato-renal syndrome, HRS) due to acute Budd-Chiari syndrome associated with complete portal vein thrombosis (BCS-PVT) for an unknown cause. Despite the initial therapy with anticoagulants, a sudden impairment of the renal function requiring hemodialysis was observed. The hepatic transplant was excluded for patient age and clinical conditions. Thus, the patient was successfully treated by emergent transjugular intrahepatic portosystemic shunt (TIPS) previous rheolytic thrombectomy of the PVT with AngioJet Ultra PE Thrombectomy System (Boston Scientific, Marlborough, MA, USA). After the procedure, the sudden resolution of the HRS was observed, and the patient is alive 13 months after hospital dismission with no TIPS dysfunction. In conclusion, emergent extended TIPS with the usage of rheolytic thrombectomy device in patient with acute BCS-PVT complicated by HRS is feasible by experienced operators and provide resolution of the HRS.
Author	Morelli, Nicola Rossi, Beatrice Colombi, Davide Michieletti, Emanuele Bodini, Flavio C. Bossalini, Margherita
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Cites_doi	10.1007/s00270-007-9198-z 10.1016/S0168-8278(02)00434-8 10.1053/gast.2001.21209 10.1016/j.jhep.2019.02.015 10.1016/j.jvir.2018.03.010 10.1136/gut.52.3.438 10.1111/j.1572-0241.2006.00353.x
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Copyright	2022 Indian National Association for Study of the Liver 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. 2022 Indian National Association for Study of the Liver
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References_xml	– volume: 120 start-page: 490 year: 2001 end-page: 497 ident: bib5 article-title: Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy publication-title: Gastroenterology – volume: 52 year: 2003 ident: bib7 article-title: Budd-Chiari syndrome with portal, splenic, and superior mesenteric vein thrombosis treated with TIPS: who dares wins publication-title: Gut – volume: 101 start-page: 83 year: 2006 end-page: 90 ident: bib2 article-title: Pathogenesis and treatment of Budd-Chiari syndrome combined with portal vein thrombosis publication-title: Am J Gastroenterol – volume: 38 start-page: 364 year: 2003 end-page: 371 ident: bib1 article-title: Budd-Chiari syndrome: a review by an expert panel publication-title: J Hepatol – volume: August year: 2022 ident: bib4 article-title: Efficacy and safety of transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome: a systematic review and meta-analysis publication-title: J Vasc Interv Radiol – volume: 71 start-page: 175 year: 2019 end-page: 199 ident: bib8 article-title: Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis publication-title: J Hepatol – volume: 31 start-page: 197 year: 2008 end-page: 199 ident: bib6 article-title: TIPS can be lifesaving in acute liver failure associated with portal vein and inferior vena cava thrombosis in a case of Budd Chiari syndrome due to protein S deficiency publication-title: Cardiovasc Intervent Radiol – volume: 29 start-page: 1327 year: 2018 end-page: 1330 ident: bib3 article-title: Extrahepatic portosystemic shunt via the coronary vein in noncirrhotic chronic portal vein thrombosis publication-title: J Vasc Interv Radiol – volume: 47 start-page: 839 year: 2000 end-page: 841 ident: bib9 article-title: Successful emergency treatment with a transjugular intrahepatic portosystemic shunt for life-threatening Budd-Chiari syndrome with portal thrombotic obstruction publication-title: Hepato-Gastroenterology – volume: 31 start-page: 197 issue: suppl 2 year: 2008 ident: 10.1016/j.jceh.2022.11.007_bib6 article-title: TIPS can be lifesaving in acute liver failure associated with portal vein and inferior vena cava thrombosis in a case of Budd Chiari syndrome due to protein S deficiency publication-title: Cardiovasc Intervent Radiol doi: 10.1007/s00270-007-9198-z – volume: August year: 2022 ident: 10.1016/j.jceh.2022.11.007_bib4 article-title: Efficacy and safety of transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome: a systematic review and meta-analysis publication-title: J Vasc Interv Radiol – volume: 38 start-page: 364 year: 2003 ident: 10.1016/j.jceh.2022.11.007_bib1 article-title: Budd-Chiari syndrome: a review by an expert panel publication-title: J Hepatol doi: 10.1016/S0168-8278(02)00434-8 – volume: 120 start-page: 490 year: 2001 ident: 10.1016/j.jceh.2022.11.007_bib5 article-title: Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy publication-title: Gastroenterology doi: 10.1053/gast.2001.21209 – volume: 71 start-page: 175 year: 2019 ident: 10.1016/j.jceh.2022.11.007_bib8 article-title: Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis publication-title: J Hepatol doi: 10.1016/j.jhep.2019.02.015 – volume: 29 start-page: 1327 year: 2018 ident: 10.1016/j.jceh.2022.11.007_bib3 article-title: Extrahepatic portosystemic shunt via the coronary vein in noncirrhotic chronic portal vein thrombosis publication-title: J Vasc Interv Radiol doi: 10.1016/j.jvir.2018.03.010 – volume: 52 year: 2003 ident: 10.1016/j.jceh.2022.11.007_bib7 article-title: Budd-Chiari syndrome with portal, splenic, and superior mesenteric vein thrombosis treated with TIPS: who dares wins publication-title: Gut doi: 10.1136/gut.52.3.438 – volume: 101 start-page: 83 year: 2006 ident: 10.1016/j.jceh.2022.11.007_bib2 article-title: Pathogenesis and treatment of Budd-Chiari syndrome combined with portal vein thrombosis publication-title: Am J Gastroenterol doi: 10.1111/j.1572-0241.2006.00353.x – volume: 47 start-page: 839 year: 2000 ident: 10.1016/j.jceh.2022.11.007_bib9 article-title: Successful emergency treatment with a transjugular intrahepatic portosystemic shunt for life-threatening Budd-Chiari syndrome with portal thrombotic obstruction publication-title: Hepato-Gastroenterology
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SubjectTerms	Budd-Chiari syndrome Hepatorenal Letter to the Editor Syndrome Transjugular intrahepatic portosystemic shunt
Title	Acute Budd-Chiari Syndrome with Complete Portal Vein Thrombosis Complicated by Hepato-Renal Syndrome Treated Successfully by Emergent TIPS with Rheolytic Thrombectomy
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