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Abstract
Portal hypertension and esophageal variceal bleeding are major medical problems specially in Egypt. The management of life threatening variceal hemorrhage in portal hypertension is a complex issue. Several forms of management exist, including drug therapy, balloon tamponade, sclerotherapy, surgical shunting and liver transplantation
Operative shunts carries the lowest rate of re-bleeding, however, mortality exceeds 50% in most series of emergency surgical portosystemic shunts for acute bleeding. These results together with high incidence of post-operative hepatic encephalopathy have made non-operative management the recommended therapy
Sclerotherapy is successful in controlling acute bleeding varices in most patients. Unfortunately, over 50% of patients re-bleed because sclerotherapy does nothing to lower the elevated portal pressure
Refractory ascites, another disabling manifestation of portal hypertension, is treated only by a procedure that lowers the elevated portal pressure
Budd Chiari disease, one of the uncommon causes of portal hypertension, has been either undiagnosed or under estimated for long duration. It is not simply a cause of portal hypertension but a fatal disorder (if untreated) that ends in liver cirrhosis and liver cell failure
Search for other safer methods for portal decompression opens the way for interventional radiological procedures
In our study, different methods of radiological hepatic vascular intervention were used to treat portal hypertension including Budd Chiari cases
Thirty patients with portal hypertension are included in this study, twenty four Budd Chiari cases and six cases with post-hepatitis cirrhosis
Budd Chiari cases underwent hepatic vein/IVC balloon angioplasty alone (four cases), hepatic vein/IVC balloon angioplasty with stenting (nine cases) and TIPS (eleven cases) Post-hepatitis cirrhosis cases (six cases) underwent TIPS
All successfully performed cases were followed up by regular clinical assessment, laboratory investigation, ultrasonogrphy and duplex examinations
Radiological hepatic vascular intervention was successful in 29 of 30 cases with a technical success 97%. Angioplasty (either with or without stenting) was successful in all cases 13 of 13 cases with technical success 100%. While TIPS was successful in 16 of 17 cases with a technical success 94%
We had no procedure related mortality. Early non fatal complications were encountered in 6 patients
During the follow up period, shunt abnormalities were detected in 5 patients where a second intervention was needed
Regarding clinical success, variceal bleeding was controlled in all cases with no recurrent or de-novo attacks of Haematemsis. Out of the successfully performed 29 cases, 28 cases exhibit either complete disappearance or significant reduction of ascites with 97% success rate. Most cases exhibit improvement of renal function while all successfully performed Budd Chiari cases showed notable improvement of liver function.