This protocol applies to Budd-Chiari syndrome presenting with short-segment (web-like) stenosis or occlusion of the hepatic veins or inferior vena cava — a pattern particularly frequent in Asian countries — in patients who have not responded adequately to initial medical management.
The first-line approach consists of anticoagulation initiated at diagnosis, phlebotomy where indicated, acetylic salicylic acid where indicated, and unspecific supportive medication. At two weeks, escalation is indicated if any of the following targets have not been met: resolution of ascites, a negative sodium and water balance, factor 5 at least 50% of normal value, or a decrease in conjugated bilirubin if it was initially elevated.
When the two-week medical targets are not met and short-segment web-like stenosis or occlusion has been confirmed, a percutaneous transluminal balloon angioplasty is the indicated interventional step. The clinical goal is restoration of splanchnic and hepatic blood flow, demonstrated by the absence of a significant pressure gradient across the stenosis. The complete procedural protocol — including access technique, stenting approach, and full algorithmic detail — is available via the link below.
Short-segment stenosis or the occlusion (the so-called web) of hepatic veins or the inferior vena cava are frequent in Asian countries.
Angioplasty should be performed without delay if a web-like BCS has been diagnosed.
A percutaneous transluminal balloon angioplasty with or without stent implantation can be performed by a transjugular, transfemoral, or percutaneous transhepatic access.
Authors concluded that routine stenting as a primary intervention may be advisable.
It is effective and safe in the first-line treatment of short-length BCS.
The recanalization of a short-segment occluded hepatic vein or the IVC may result in the restoration of the splanchnic and hepatic blood flow and lead to a clinical improvement.
After successful angioplasty (demonstrated by lack of a significant gradient across the stenosis), the hepatic venous pressure gradient should be determined.
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