Aim: To evaluate the effectiveness and clinical outcomes of our percutaneous transjugular intrahepatic portosystemic shunt (TIPS) technique via direct simultaneous puncture of portal vein (PV) and inferior vena cava (IVC) in management of Budd-Chiari patients.
Materials and Methods: We previously described a method of TIPS insertion designed to overcome the problems associated with portal venous puncture performed by the transjugular route alone. Our technique involves percutaneous insertion of the needle under sonographic guidance through a PV branch and then into the IVC to facilitate insertion of a guidewire, which is snared through a jugular venous puncture.  Screening doppler USs were done at the first day, first week, first month and third month of the procedure. Portography and pressure measurements were performed every year if no shunt dysfunction was detected before.
Results: From January 2006 to September 2019, we performed TIPS in 49 consecutive patients (mean age, 36 years) with BCS (9 patients with acute BCS and 40 patients with subacute and chronic BCS).  Mean follow-up was 62 months (range,5 -141). TIPS procedure was technically successful in all patients. In all patients, bare stents were used. Patients were anticoagulated with warfarin after the procedure. Early thrombosis (in one week) was diagnosed in 12 (25%) patients and TIPS revision was required. One year primary patency was 55.6%. Clinical success was achieved in 44 patients. 5 patients required liver transplantation because of liver function deterioration but only 3 of them had liver transplantation (7 months, 1.5 year and 2 year later from TIPS) other 2 patients died while waiting for deceased donation.
Conclusion: Our experience suggests that percutaneous direct simultaneous puncture of portal vein and inferior vena cava is an effective bridging therapy to liver transplantation for patients with Budd-Chiari syndrome.