Treating Budd-Chiari syndrome - Making rational choices from a myriad of options

Budd-Chiari syndrome represents a spectrum of disorders characterized by ob struction to hepatic venous drainage. Originally described as an "obliterat ing endophlebitis of the hepatic veins," this condition has come to refer t o the manifestations of hepatic venous outflow obstruction anywhere above t he level of: the hepatic venulae regardless of the etiology, position, or s everity of the obstruction or of the clinical course. Depending on the natu re and anatomy of the obstruction, the disease presents acutely, with a rap idly progressive course, or insidiously, with gradual development of sympto ms. The optimal management strategy for a given patient with Budd-Chiari sy ndrome depends on the anatomy of the obstruction, its physiologic consequen ces, and the natural history of the specific lesion. The specific treatment s available and their use in the treatment of Budd-Chiari syndrome are revi ewed.