This protocol is for patients with Budd-Chiari syndrome caused by short-segment (web-like) stenosis or occlusion of the hepatic veins or the inferior vena cava — a pattern especially prevalent in Asian populations. When a prior shunting procedure has been performed but has not met the required haemodynamic and renal targets, the question of next-line management arises.
This protocol applies after transjugular intrahepatic portosystemic shunt (TIPS) has been performed and has failed to achieve its required goals within two weeks — specifically, adequate reduction of the portosystemic pressure gradient and normalisation of creatinine concentration. Failure to reach these targets is the trigger for escalation to this next management step.
The protocol at this stage centres on a major surgical transplant-based intervention. Full eligibility criteria, timing considerations, and procedural details are available in the structured protocol 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.
Liver transplantation performed during the MELD era delivers results comparable to TIPS with actuarial overall survival rates of 76–85%, 71%, and 68% at one year, five years, and ten years, respectively.
DOI: 10.3390/diagnostics13081458
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