Anticoagulation therapy

If blood clots cause your Budd-Chiari syndrome, you will probably be offered anticoagulation therapy.

This involves taking medicines to stop or reduce blood clots. You may need to take these medicines for the rest of your life. You will also need regular checks to make sure it is working and is not causing you to bleed too much.

The NHS has more information on anticoagulant medicines.

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Procedures to unblock veins

Doctors will try to pinpoint the exact areas where blood flow is getting blocked. If possible, they will then try to remove the blockages.

This is usually done using a procedure called angioplasty.

What happens during an angioplasty for Budd-Chiari syndrome?

You will usually be given a sedative to help you feel sleepy and relaxed. You will also have a local anaesthetic. So you should not feel any pain during the procedure.

More about anaesthetics and sedation.

The procedure is usually carried out by a specialist called a radiologist. They will put a thin flexible tube into your blood vessels. The tube is called a catheter. It is usually put into a vein in your neck. A doctor injects a dye through the tube into your veins. This is called a contrast dye or contrast medium. The doctor uses X-rays to look at the dye. This helps them to see the blockages and to carefully move the tube towards them.

The doctor may then be able to remove the blockage and open the vein. They can use a small balloon to gently open the vein. They might also put a small tube called a stent into the vein to hold it open.

If the clot formed recently, the tube might stay in for a day or two. This allows medicines to help get rid of the clot. Doctors might call this clot-busting treatment “thrombolysis”.

After the procedure

You may need to stay in hospital after the procedure. If you are allowed to go home, you will need someone to take you home and stay with you overnight.

If the angioplasty was able to open the veins, then you should start to feel a lot better. But talk to the radiologist or your medical team for personal advice before you leave hospital.

Things to ask the medical team before you go home:

• If I need pain medication, what should I take?
• When can I do all my usual activities?
• Are there any possible problems I should look out for? What should I do if they happen?
• How long will it take for me to start feeling better?
• When will I have a follow-up appointment, and how will I find out about it?
• Who should I contact if I have any problems or questions before then?

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TIPS procedure

If angioplasty cannot clear the blockages, a procedure called TIPS might be suggested.

TIPS stands for transjugular intrahepatic portosystemic shunt or stent. You might also see it written as TIPSS.

The TIPS procedure creates a “bypass.” A tube is used to make a new route for the blood going through the liver. This can reduce the pressure in the liver and in the veins around it.

But like all procedures, not everyone can have TIPS and it is important to talk to your medical team about the risks and benefits for you.

For some types of liver disease TIPS can increase the risk of a complication called hepatic encephalopathy (HE). But this is much less common when TIPS is done for Budd-Chiari syndrome.

Find out more about the TIPS procedure.

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Liver transplant for Budd-Chiari syndrome

A liver transplant can be used to treat Budd-Chiari syndrome. But it is only suggested when other treatments do not work and the liver is severely damaged.

A liver transplant is a very big operation. The surgery has risks, and there is a need for lifelong follow-up and medication.

Doctors might suggest a liver transplant if other treatments have failed or are not suitable and:

• your liver has failed because of fulminant Budd-Chiari, or
• your liver has severe long-term damage

We have much more information about liver transplants online and in our booklets. This includes information for the family and friends of people having a transplant.

Find out more about liver transplants.

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