Hepatic Vein Thrombosis (Budd-Chiari Syndrome)

Written by April Kahn | Published on June 30, 2012
Medically Reviewed by George Krucik, MD

What Is Hepatic Vein Thrombosis?

Hepatic vein thrombosis (HVT) is an obstruction in the veins of the liver caused by a blood clot. This condition blocks blood flow from the liver to the heart. Without proper blood flow, the liver stops getting the oxygen it needs to function, and can become seriously damaged.

The symptoms caused by HVT vary from person to person. Some people have no symptoms at all.

HVT is also called Budd-Chiari syndrome.

What Causes Hepatic Vein Thrombosis?

HVT can be caused by certain medications, diseases, and inherited disorders. Anything that can cause blood clotting in the veins of the liver may lead to HVT. The most common causes of HVT are:

  • blood disorders
  • liver cancer
  • liver trauma
  • infections
  • vein inflammation (phlebitis)
  • birth control pills
  • pregnancy
  • immunosuppressive drugs
  • autoimmune disorders
  • inflammatory disorders
  • connective tissue disorders

What Are the Symptoms of Hepatic Vein Thrombosis?

Not everyone with HVT will have symptoms. For those that do, the most common symptom is a buildup of fluid in the abdomen and an enlarged liver. This is caused by pressure buildup behind the blockage.

Other symptoms of HVT include:

  • nausea and vomiting
  • vomiting blood
  • weight loss
  • enlarged spleen
  • swelling of lower limbs
  • abdominal pain (mainly to the upper right)
  • jaundice (yellowing of the skin and eyes)

If you develop any of the symptoms of HVT, consult your doctor.

How Is Hepatic Vein Thrombosis Diagnosed?

HVT is diagnosed with blood tests and a physical exam.

During the exam, your doctor will press gently on your abdomen to feel for the presence of fluid or an enlarged liver.

A blood sample can be used to check if the liver is working properly. If there are signs of liver damage, you may need an imaging test.

Your doctor may order an ultrasound of the liver to check its size and for signs of damage. A computed tomography scan (CT scan) can also be used to look for obstructions and damaged tissue.

If your doctor spots abnormalities in your liver, you may need a liver biopsy. A piece of your liver will be removed to look for damage.

Pressure within the vein can also be measured directly. A small instrument is inserted into the hepatic vein through a catheter. This procedure is called hepatic vein catheterization.

How Is Hepatic Vein Thrombosis Treated?

Medication

HVT can often be treated with anticlotting medications. Medications used to dissolve blood clots are called fibrinolytic drugs. Your doctor may also prescribe anticoagulants to prevent future blood clots.

Surgery

Your doctor may choose to widen your hepatic vein to improve blood flow. This procedure is called percutaneous transluminal angioplasty. A surgeon feeds a catheter into the blocked vein. The catheter has a deflated balloon at the tip, which is inflated once in the vein. This causes the vein to widen. Once the vein is wide enough, the surgeon inserts wire mesh into the vein. This holds it open.

Transjugular intrahepatic portal-systemic shunting (TIPS) may also be used to deflect blood flow from away from the liver. This releases pressure on the portal vein. TIPS surgery inserts a shunt to redirect the blood flow.

Future Health Complications and Outlook

The main complication of untreated HVT is liver failure. People with liver failure may die within three years without a transplant. Additional complications may arise from surgeries used to correct HVT.

An untreated blockage in the hepatic vein can be fatal. Life expectancy after treatment varies. It depends on:

  • blockage location
  • speed of treatment
  • type of treatment
  • the underlying cause of your HVT
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