Budd-Chiari syndrome (Hepatic Vein Thrombosis) treated with DIPS procedure
PACE Hospitals
A 45-year-old female presented with a history of recurrent fluid filling in the abdomen and jaundice. She was diagnosed to have liver disease. She had to undergo repeated painful procedures of removal of fluid from the abdomen, which required multiple hospitalizations.
Although she was evaluated at various other hospitals, her exact cause of liver disease and recurrent fluid filling in the abdomen is not diagnosed. In PACE Hospitals we were able to diagnose the condition as Budd-Chiari syndrome.
The patient normal liver veins which carry the blood back to the heart were all blocked. Due to the blockage of these veins venous pressure in the liver and abdominal veins increased leading to liver disease and repeated fluid accumulation in the abdomen.
So to treat this condition, we did an interventional radiology procedure called Direct Intrahepatic Portosystemic Shunt (DIPS).
DIPS or TIPS (Transjugular Intrahepatic Portosystemic Shunt) is considered as one of the most difficult interventional radiology procedure. It is performed in only a handful of centers in India.
Dr. Lakshmi Kumar Chalamarla,
who is specially trained in liver related interventional radiology procedures, could accomplish this task in just 30 minutes. We also have the
Philips Azurion Cath Lab
- the next generation image-guided therapy platform and other equipment to perform these procedures.
DIPS Procedure - images
Post procedure, the patient’s complaints of fluid filling in the abdomen decreased and there is no need of fluid removal from the abdomen now. Her liver condition also improved, which increases her life span and also postpones or avoids the need for liver transplantation.
What is Budd-Chiari Syndrome?
Budd-Chiari syndrome is a condition in which the outflow of blood from liver is obstructed. The obstruction can be due to clotting in smaller veins (hepatic veins) or larger vein (inferior vena cava). The stagnant blood in the liver causes liver cell damage.
What are the Causes of Budd-Chiari Syndrome?
Budd-Chiari Syndrome is more commonly seen in patients who are prone to clotting of blood due to certain blood disorders like myeloproliferative disorders, polycythaemia or sickle cell anaemia. Pregnancy and oral contraceptive pills usage are also risk factors. Other causes are webs in inferior vena cava (which is a large vein that carries blood from legs and lower body to the heart), trauma, infections, and other rare diseases.
What are the Symptoms of Budd-Chiari Syndrome?
This presents with symptoms like
- abdominal pain
- abdominal fullness (due to fluid accumulation)
- jaundice (yellowish discoloration of eyes)
- blood vomiting
- black colored stools
- swelling of legs
- altered mental state
How is Budd-Chiari syndrome Diagnosed?
Budd-Chiari syndrome is diagnosed using imaging techniques like Ultrasound Doppler, CT venogram or MR venogram. Underlying blood disorders are diagnosed by doing blood tests. The extent of liver damage is assessed by biopsy or by testing liver elasticity or by estimating the pressure in liver veins.
How is Budd-Chiari Syndrome Treated?
If Budd-Chiari syndrome is detected early, medicines to break the clots can be used for treatment. But most of the time this is detected late. These patients can be treated with interventional radiology techniques. These techniques include opening the blocked vein using balloon (angioplasty) or stent. In patients with veins not amenable for opening, TIPS procedure can be done. In this procedure, a new outflow to liver blood is created by bridging the inflow vessel (portal vein) and the inferior vena cava.
In patients with very severe acute disease or very late disease with permanent liver cell damage liver transplantation is the treatment offered.
What is the Prognosis of Budd-Chiari Syndrome?
It depends upon the time of detection. Prognosis is better for those detected early before severe liver damage.
How to Prevent Budd-Chiari Syndrome?
Early detection of blood disorders and their close monitoring is the best possible way to prevent this condition
Frequently Asked Questions on Budd-Chiari Syndrome (Hepatic Vein Thrombosis)
What are the early warning signs of Budd-Chiari Syndrome?
Early symptoms may include abdominal discomfort, liver enlargement, mild ascites, or unexplained fatigue. Because symptoms can be subtle initially, diagnosis is often delayed unless imaging or blood tests are performed early.
Can Budd-Chiari Syndrome develop suddenly?
Yes. Acute Budd-Chiari Syndrome may develop rapidly when a clot suddenly blocks hepatic veins. This can cause severe abdominal pain, jaundice, and rapid liver dysfunction, requiring urgent medical intervention.
What conditions increase the risk of Budd-Chiari Syndrome?
Risk factors include blood clotting disorders, certain cancers, pregnancy, long-term oral contraceptive use, and chronic inflammatory conditions. In many patients, an underlying hypercoagulable state is identified.
How is Budd-Chiari Syndrome diagnosed?
Diagnosis usually involves Doppler ultrasound, CT scan, or MRI to assess hepatic vein flow. Blood tests help evaluate liver function and identify clotting abnormalities contributing to the condition.
What is the DIPS procedure and when is it used?
The Direct Intrahepatic Portosystemic Shunt (DIPS) procedure creates an alternate pathway for blood to bypass blocked hepatic veins. It is especially useful when conventional shunt procedures are not feasible.
What complications can occur if Budd-Chiari Syndrome is untreated?
Untreated disease can lead to cirrhosis, portal hypertension, ascites, variceal bleeding, and eventual liver failure. Early treatment significantly improves outcomes.
Can Budd-Chiari Syndrome recur after treatment?
Recurrence is possible, especially if the underlying clotting tendency is not controlled. Lifelong follow-up and medication adherence are essential to prevent re-thrombosis.
Why is Budd-Chiari Syndrome often diagnosed late?
This condition may progress silently because early liver congestion does not always produce obvious symptoms. Many patients adapt gradually to changes until complications such as ascites or portal hypertension appear. Delayed recognition highlights the importance of high clinical suspicion and timely imaging.
How does Budd-Chiari Syndrome differ from other causes of portal hypertension?
Unlike portal hypertension caused by cirrhosis, Budd-Chiari Syndrome originates from impaired venous outflow rather than liver scarring alone. This distinction influences treatment choices and makes early vascular intervention more effective.
Is Budd-Chiari Syndrome related to kidney problems?
Although it primarily affects the liver, advanced disease may indirectly impact kidney function due to fluid imbalance, reduced circulation, and complications such as hepatorenal syndrome in severe cases.
What role does imaging play in treatment planning?
Imaging determines the extent of venous blockage and guides treatment decisions. It helps doctors decide whether medication, interventional procedures, or advanced techniques like DIPS procedure are required.
Can medications alone treat Budd-Chiari Syndrome?
In early or mild cases, anticoagulants and symptom-based treatment may be sufficient. However, when venous obstruction is severe or persistent, procedural intervention is often necessary to restore blood flow.
How does DIPS differ from other shunt procedures?
Unlike traditional shunts, DIPS procedure directly connects the portal vein to the inferior vena cava. This approach is beneficial in patients with complete hepatic vein obstruction.
Is DIPS a permanent solution?
DIPS helps relieve portal hypertension and improves symptoms, but long-term success depends on ongoing monitoring, anticoagulation, and management of underlying clotting disorders.
What is the long-term outlook for patients with Budd-Chiari Syndrome?
With timely diagnosis and appropriate intervention such as DIPS procedure, many patients experience improved liver function and quality of life. Prognosis depends on disease severity and underlying causes.
How does PACE Hospitals evaluate Budd-Chiari Syndrome patients?
At PACE Hospitals, evaluation includes:
- Advanced imaging to assess hepatic venous obstruction
- Blood tests to identify clotting disorders
- Multidisciplinary review involving hepatology and interventional radiology
- Individualized treatment planning based on disease severity
When is the DIPS procedure recommended at PACE Hospitals?
The DIPS procedure may be advised when:
- Hepatic veins are completely blocked
- Symptoms persist despite medication
- Portal hypertension complications develop
- Conventional shunt procedures are not suitable
What makes PACE Hospitals experienced in managing Budd-Chiari Syndrome?
PACE Hospitals offers:
- Expertise in complex liver vascular disorders
- Advanced interventional radiology facilities
- Integrated care across hepatology, imaging, and critical care
- Focus on minimally invasive treatment approaches
How does PACE Hospitals support recovery after DIPS procedure?
Post-procedure care includes:
- Regular imaging to ensure shunt patency
- Monitoring liver function and clotting status
- Long-term anticoagulation management
- Patient education on lifestyle and follow-up care
Why choose PACE Hospitals for Budd-Chiari Syndrome treatment?
Patients choose PACE Hospitals for:
- High success rates in advanced liver interventions
- Personalized treatment strategies
- Comprehensive follow-up and monitoring
- Commitment to improving long-term liver health
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