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Inicio Gastroenterología y Hepatología Procedimientos radiológicos intervencionistas, angioplastia y DPPI en el tratam...
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Vol. 26. Núm. 8.
Páginas 461-464 (enero 2003)
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Vol. 26. Núm. 8.
Páginas 461-464 (enero 2003)
Acceso a texto completo
Procedimientos radiológicos intervencionistas, angioplastia y DPPI en el tratamiento del síndrome de Budd-Chiari
Interventional radiology, angioplasty and tips in budd-chiari syndrome
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5036
O. Núñeza, G. de la Cruza, J. Molinaa, G.M. Borregoa, I. Marína, A. Ponferradaa, V. Catalinaa, A. Echenagusiab, R. Bañaresa,
Autor para correspondencia
rbanares@telefonica.net

Correspondencia: Dr. R. Bañares Cañizares. Servicio de Aparato Digestivo. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo, 46. 28007 Madrid. España.
a Servicio de Aparato Digestivo. Hospital General Universitario Gregorio Marañón. Madrid. España
b Servicio de Radiología. Hospital General Universitario Gregorio Marañón. Madrid. España
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Estadísticas
Introducción

El síndrome de Budd-Chiari (SBC) es una obstrucción, completa o parcial, del drenaje venoso hepático. El tratamiento del SBC tiene múltiples opciones; las nuevas técnicas radiológicas intervencionistas pueden tener un papel relevante frente al tratamiento derivativo quirúrgico.

Pacientes y método

Siete de 11 pacientes diagnosticados de SBC fueron tratados mediante angioplastia percutánea con balón o derivación portosistémica percutánea intrahepática (DPPI) (2 y 5 pacientes, respectivamente). Se evaluó la eficacia de ambas técnicas en el tratamiento del SBC.

Resultados

Dos pacientes presentaban estenosis significativas aisladas de una vena suprahepática y recibieron tratamiento con angioplastia percutánea con balón, con buena evolución y resolución de la ascitis en ambos casos. Cinco pacientes recibieron una DPPI. Cuatro de los 5 pacientes mostraron mejoría clínica con una reducción significativa del índice de Child-Pugh (p < 0, 05) y la resolución de la ascitis. Durante el seguimiento no se detectó ninguna disfunción de la DPPI. Un paciente murió precozmente sin mejoría tras la DPPI, y otros dos por causas relacionadas con su enfermedad de base durante el seguimiento.

Conclusiones

El tratamiento del SBC requiere una valoración multidisciplinaria y debe ser individualizado. En los pacientes en que el SBC no puede ser controlado médicamente, la DPPI se podría establecer como la medida de descompresión de elección frente a las derivaciones quirúrgicas, reservando el trasplante hepático para cuando éstas no son eficaces.

Introduction

Budd-Chiari syndrome consists of complete or partial obstruction of the hepatic veins. Many treatment options are available; new interventional radiology techniques may play an important role as an alternative to surgical shunting.

Patients And Method

Of 11 patients diagnosed with Budd-Chiari syndrome, 7 were treated with percutaneous balloon angioplasty or transjugular intrahepatic portosystemic shunt (TIPS) (2 and 5 patients, respectively). The efficacy of both techniques in the treatment of this syndrome was evaluated.

Results

Two patients presented significant isolated stenosis of a suprahepatic vein and underwent percutaneous balloon angioplasty. In both patients outcome was favorable with resolution of ascites. Five patients underwent TIPS and four showed clinical improvement with significant reduction in Child-Pugh score (p < 0.05) and resolution of ascites. No shunt malfunction was detected during follow-up. One patient showed no improvement after placement of TIPS and died soon after the procedure and a further two died from their underlying disease during follow-up.

Conclusions

Treatment of Budd-Chiari syndrome requires multidisciplinary evaluation and should be individualized. In patients with Budd-Chiari syndrome uncontrolled by medical therapy, TIPS may become the decompressive method of choice as an alternative to surgical shunting. Liver transplantation may be reserved to patients in whom these techniques are ineffective.

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Copyright © 2003. Elsevier España, S.L.. Todos los derechos reservados
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