| Treatment of Budd-Chiari syndrome due to inferior vena cava occlusion by combined portal and vena caval decompression. | |
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MedLine Citation:
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PMID: 1733362 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This study concerns Budd-Chiari syndrome (BCS) caused by occlusion of the subdiaphragmatic inferior vena cava (IVC). It describes the experimental and clinical evaluation of the treatment of this disorder by one-stage combined portal and vena caval decompression with a direct side-to-side portacaval shunt (PCS) and a caval-atrial shunt (CAS) graft. BCS was produced in rats by gradual occlusion of the suprahepatic IVC with an ameroid constrictor. When ascites and portal hypertension were established, 12 control rats survived a sham thoracolaparotomy, 16 rats survived a mesoatrial shunt, and 16 rats survived combined PCS and CAS graft. All control rats re-formed ascites and died within 2 months. Nine of 16 rats with mesoatrial shunt developed graft thrombosis, re-formed ascites, and died within 2 months. In contrast, only 2 of 16 rats that underwent combined PCS and CAS developed graft thrombosis, re-formed ascites, and died. Liver biopsies showed reversal of severe pathologic changes in rats with patent grafts. Clinical evaluation of combined PCS and CAS using a 20-mm ring-reinforced Gore-Tex graft has been undertaken in five patients with BCS and ascites, hepatosplenomegaly, intense hepatic congestion on biopsy, and angiography showing occlusion of both the IVC and hepatic veins. All five patients are alive and well 6 months to 7.5 years postoperatively with patent grafts, no ascites or need for diuretics, no encephalopathy, normal liver function, and reversal of liver pathology. It is concluded that combined PCS and CAS create a high-flow shunt that decompresses both the portal system and IVC, has a low incidence of graft thrombosis, has been consistently effective in relieving BCS caused by IVC occlusion, and appears to be superior to mesoatrial shunt. |
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Authors:
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M J Orloff; P O Daily; B Girard |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American journal of surgery Volume: 163 ISSN: 0002-9610 ISO Abbreviation: Am. J. Surg. Publication Date: 1992 Jan |
Date Detail:
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Created Date: 1992-02-25 Completed Date: 1992-02-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370473 Medline TA: Am J Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 137-42; discussion 142-3 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, School of Medicine, University of California, San Diego, La Jolla. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Animals Blood Vessel Prosthesis* Budd-Chiari Syndrome / etiology, surgery* Constriction Heart Atria / surgery Humans Male Polytetrafluoroethylene Portacaval Shunt, Surgical* Rats Rats, Inbred Lew Thrombosis / complications* Vena Cava, Inferior* |
| Grant Support | |
ID/Acronym/Agency:
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AM-17103/AM/NIADDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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9002-84-0/Polytetrafluoroethylene |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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