Risk Factors and Predictors of Occlusion of Stent of Trans Jugular Intrahepatic Porto-systemic Shunt (TIPSS) in Egyptian Patients with Primary Budd Chiari Syndrome

Abstract

Budd Chiari syndrome is a rare disorder which is characterized by hepatic venous outflow tract obstruction. The classical triad of presentation are ascites, hepatomegaly and abdominal pain. Early diagnosis and proper treatment improve the overall survival and decreases morbidity and mortality, anticoagulation is main line of treatment, angioplasty, stenting and TIPSS provides way of decompression of the congested liver. TIPSS is used as the most common line of treatment in treating BCS patients with good outcome in case of good patient selection. TIPSS occlusion remains a major problem after intervention which require regular follow up and shunt revision for proper identification and restoring patency. The prevalent thrombophilia etiology in the studied group was FVLM (69.7%) then MTHFRD (67.1%). The overall rate of stent occlusion in 6 months among the patients was 50 % with highest rate of occlusion at 7 days post TIPSS and 3 months. After analyzing the results, we found that there is no significant relation between age, sex and TIPSS stent occlusion. Different etiologies of BCS may be a risk factor for stent occlusion. Patients with AT III deficiency and PRV carried a higher rate of occlusion. Also cirrhotic and coarse liver by ultrasound may predict stent occlusion.