Budd Chiari syndrome (BCS) is a clinical condition resulting from impaired hepatic venous drainage, due to obstruction of hepatic venous outflow at any level extending from the small hepatic veins to the junction of the inferior vena cava and the right atrium leading to hepatic congestion. Untreated cases have high mortality rates: up to 90% at 3 years post presentation [1]. We aim to highlight the various endovascular techniques at the disposal of the interventional radiologists for the treatment of this disease with pictorial examples...

PATHOPHYSIOLOGY: The primary pathophysiology is thrombosis of HV, suprahepatic IVC or both – termed PRIMARY BCS [2]. Outflow of blood from liver may also occur due extrinsic compression from space occupying lesions, tumour thrombi, pericardial disease etc.: resulting in clinical symptoms similar to primary HVOTO – termed SECONDARY BCS[2]. Figure 1[Fig 1] Acute thrombosis leading to alteration of physiological blood flow, results in acute symptoms of liver failure with rapidly developing ascites, pedal edema, abdominal wall venous distention etc. The classic ‘flip-flop’ enhancement is seen...

The objective of the treatment is to relieve hepatic venous outflow obstruction and improving liver perfusion. The treatment is governed by prognostic factors, potential for parenchymal recovery, surgical risk, and availability of live donor as well as the stage of disease at which the patient presents. Anticoagulation therapy: Early initiation of anticoagulation therapy is recommended in all patients 2 Catheter Directed Thrombolysis: Catheter-assisted thrombolysis decreases systemic exposure to the drug. Better success rates are achieved when it is combined with angioplasty and/or stenting, especially in...

BCS has diverse aetiologies and presentation. Various endovascular treatment modalities exist for Budd Chiari Syndrome. With sound knowledge of USG, Doppler and cross section imaging and with appropriate patient selection the various treatments can be planned. Budd Chiari syndrome is a common cause of chronic liver disease in Asian countries and it is extremely essential that we are all aware of the various endovascular treatment options so that further liver damage can be prevented. If the disease progresses to fulminant hepatic failure then liver transplantation...

A. Israr: Nothing to disclose R. R. Yadav: Nothing to disclose S. Singh: Nothing to disclose K. B. K. Rangan: Nothing to disclose R. V. Mall: Nothing to disclose

Valla DC. Primary Budd-Chiari syndrome. J Hepatol 2009; 50: 195–203. Valla DC. Budd-Chiari syndrome/hepatic venous outflow tract obstruction. Hepatol Int. 2018 Feb;12(Suppl 1):168-180. doi: 10.1007/s12072-017-9810-5. Epub 2017 Jul 6. PMID: 28685257. Maha Torabi, Keyanoosh Hosseinzadeh, Michael P. Federle. CT of Nonneoplastic Hepatic Vascular and Perfusion Disorders. RadioGraphics 2008; 28:1967–1982. Doi: 10.1148/rg.287085067. Okuda K. Inferior vena cava thrombosis at its hepatic portion (obliterative hepatocavopathy). Semin Liver Dis 2002;22:15–26. On-Koo Cho, Ja-Hong Koo, Yong-Soo Kim et al. Collateral Pathways in Budd-Chiari Syndrome: CT and Venographic Correlation. AJR...