To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) guided by three-dimensional visualization technology in the treatment of Budd-Chiari syndrome (BCS).

Clinical data of 32 patients with BCS with extensive hepatic vein obliterans undergoing TIPS in the Affiliated Hospital of Xuzhou Medical University from January 2017 to February 2021 were retrospectively analyzed. Among them, 14 patients were male and 18 female, age (40±14) years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the different guided methods of TIPS, all patients were divided into thethree-dimensional visualization group (visualization group, n=11), direct portography group (direct portography group, n=10) and indirect portography group (indirect portography group, n=11). The puncture effect and safety were observed among three groups. The quantity of portal vein puncture and puncture time were compared among three groups by using one-way ANOVA and LSD-t test. The initial patency rate was statistically compared by Kaplan-Meier method and Log-rank test.

All 32 patients successfully underwent TIPS. Portal vein could be clearly displayed in the visualization group and direct portography group, whereas the left and right branches of portal vein in 2 patients could not be explicitly displayed in the indirect portography group. In the visualization, direct portography and indirect portography groups, the quantity of portal vein puncture was (2.8±1.0), (3.1±1.3) and (4.8±2.4) times, and the puncture time was (18±14), (26±8) and (42±18) min, respectively. The quantity of portal vein puncture and puncture time in the visualization group were significantly shorter compared with those in indirect portography group (LSD-t=-3.510, -3.953;P<0.05). No postoperative complications were observed in the visualization and indirect portography groups, and subcapsular hemorrhage occurred in 1 case in the direct portography group. The initial patency rate within postoperative 1-year was 100.0%, 90.0% and 90.9% in three groups, respectively. No significant difference was noted (χ²=0.069,P>0.05). During the postoperative follow-up, 1 case of in-stent restenosis was reported in each group, and all were treated with balloon dilatation. 1 case of grade Ⅰ hepatic encephalopathy was found in the visualization and direct portography group respectively, who were alleviated after conservative treatments.

TIPS guided by three-dimensional visualization is a safe and feasible noninvasive treatment for BCS with extensive hepatic vein obliterans. It possesses multiple advantages of accurate localization, low quantity of portal vein puncture and short puncture time, which has high application value in the clinical practice.