In Reply to: Re: Case 0498_09 --Hepatic vein occlusion posted by Moni Stein on April 06, 1998 at 12:55:30:
I would certainly agree with the others that it
appears like Budd-Chiari.I personally think that
TIPS is a better option than surgery.We have had
two cases treated with TIPS that has been doing
well for the past two years.The last one was as
a result of PNH.As you probably know they are
technically difficult to do.In this last one we
had trouble with the Colapinto set(parenchyma very
soft) and we ended up using the Quick-Core set for
TJLB and substituding the neddle for a 21 g Cope
to make the puncture into the Portal vein from a
stump of Lt.hepatic vein with success.We reduced
the gradient from 42mm to 5mm.He has done so well
that he recently had a succsesful Bone Marrow
transplant.Did you measure pressures in the IVC
and RA?. I bet you there was a significant gra-
dient which would have precluded a M-C shunt.Both
cases have been anticoagulated post TIPS.Look at
the article that was previously mentioned.It has
a good series of cases.Great case!. Good Luck!