Combined Budd-Chiari syndrome and portal vein thrombosis is a challenging clinical condition with as yet unknown outcome.
Dr Sarwa Darwish Murad and colleagues investigated the etiology, treatment, and prognosis of Budd-Chiari syndrome with portal vein thrombosis.
The team diagnosed patients with nonmalignant Budd-Chiari syndrome between 1984 and 2001.
The patients were classified into 3 groups.
Group 1 included 204 patients with isolated Budd-Chiari syndrome.
Group 2 had 15 patients with portal vein thrombosis without spleno-mesenteric vein thrombosis.
Group 3 consisted of 18 patients with Budd-Chiari syndrome - portal vein thrombosis with spleno-mesenteric vein thrombosis.
The researchers found that multifactorial etiology was present in 58% of patients with combined Budd-Chiari syndrome and portal vein thrombosis.
The research team noted that the number of etiological factors increased significantly with the extent of thrombosis.
The main treatment options included anticoagulation and portosystemic shunting, of which extended TIPS showed the most beneficial results.
|5-year survival was 59% in Budd-Chiari syndrome - portal vein thrombosis|
|American Journal of Gastroenterology|
The team observed that the 5-year survival was 59% in Group 2 versus 85% in Group 1.
Survival tended to be worse in patients in Group 1 as compared to patients in Group 2 presenting without spleno-mesenteric vein thrombosis.
Dr Murad's team concluded, “In Budd-Chiari Syndrome, extension of thrombosis into the splanchnic venous bed was significantly related to the number of etiological factors, and was associated with poor outcome.”
“These results strongly support a liberal use of anticoagulants, which so far had been widely debated.”
“Alternatively, derivative shunt procedures appear difficult, yet not impossible.”