Vascular Diseases of the Liver

The Budd–Chairi syndrome (BCS) is a consequence of hepatic venous outflow obstruction at the hepatic venules, major hepatic veins, or inferior vena cava. The prevalence and etiology of BCS demonstrates significant geographic heterogeneity. The clinical manifestations of BCS are similarly variable and depend on the extent and acuity of obstruction. Medical management of BCS relies on identification of the precipitating factor, anticoagulation to prevent propagation of the obstruction, and sodium restriction and diuretics to manage ascites. In select cases, hepatic venous outflow obstruction can be relieved through the use of thrombolytics, angioplasty, and stenting, or transjugular intrahepatic portosystemic shunting (TIPS).