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Understanding Hepatic Vein Thrombosis (Budd-Chiari Syndrome)

What is hepatic vein thrombosis?

Hepatic vein thrombosis (HVT) is an obstruction in the hepatic veins of the liver caused by a blood clot.

This condition blocks the drainage system of your liver, impeding blood flow back to your heart. Without proper blood flow, your liver stops getting the fresh oxygen it needs to function. This can severely damage your liver and may lead to liver failure.

Read more: What you should know about hepatic failure »

The symptoms caused by HVT vary from person to person. Some people may have no symptoms until the blockage causes liver damage.

HVT is also called Budd-Chiari syndrome.

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Causes

Causes of HVT

Certain medications, diseases, and inherited disorders can cause HVT. Anything that can cause blood clotting in the veins of your liver may lead to HVT.

The most common causes of HVT are:

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Symptoms

Symptoms of HVT

Not everyone with HVT will have noticeable symptoms in the early stages of the condition. For those who do, the most common symptoms are buildup of fluid in their abdomen and an enlarged liver. This is caused by pressure buildup behind the blockage.

Other symptoms of HVT include:

Call your doctor if you experience any of these. Prompt treatment will prevent liver damage and give you a better outlook for recovery.

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Diagnosis

Diagnosing HVT

Your doctor can diagnose HVT by taking your medical history, running blood tests, and performing a physical exam.

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

A blood sample can show if your liver is working properly. You may need an imaging test if the blood test results show liver damage.

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

You may need a liver biopsy if your doctor spots abnormalities in your liver. To perform a biopsy, your doctor removes a small piece of tissue from your liver to look for damage.

Learn more: Liver biopsy »

Your doctor can also measure pressure within your hepatic veins. To do this, they insert a small instrument through a catheter into a vein. This procedure is called hepatic vein catheterization.

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Treatment

Treatment for HVT

Medication

Anticlotting medications can often treat HVT. Medications used to dissolve blood clots are called fibrinolytic drugs. Your doctor may also prescribe anticoagulants to prevent blood clots.

Surgery

Your doctor may choose to widen the affected hepatic vein to improve blood flow. This procedure is called percutaneous transluminal angioplasty.

During the procedure, a surgeon feeds a catheter into the blocked vein. The catheter has a deflated balloon at its tip, which the surgeon inflates once it’s 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.

Your surgeon may use transjugular intrahepatic portosystemic shunting to redirect the blood flow away from your liver. This releases pressure on your portal vein, which is responsible for moving blood into your liver.

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Complications

Future health complications and outlook

Untreated HVT can lead to liver failure. People with liver failure who don’t receive a transplant may have a three-year life expectancy.

The effectiveness of your treatment plan will depend on many factors, including:

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

HVT doesn’t always have noticeable symptoms in its early stages. You’ll have a better outlook if you get an early diagnosis and start treatment immediately.

Schedule regular checkups with your doctor and tell them if you’re experiencing symptoms you’re concerned about. This will make catching potentially serious health conditions in the early stages more likely.

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