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Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL)

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Abstract

Budd Chiari syndrome (BCS) is a diverse disease with regard to the site of obstruction, the predisposing thrombophilic disorders and clinical presentation across the Asia-Pacific region. The hepatic vein ostial stenosis and short segment thrombosis are common in some parts of Asia-Pacific region, while membranous obstruction of the vena cava is common in some and complete thrombosis of hepatic veins in others. Prevalence of myeloproliferative neoplasms and other thrombophilic disorders in BCS varies from region to region and with different sites of obstruction. This heterogeneity also raises several issues and dilemmas in evaluation and approach to management of a patient with BCS. The opportunity to recanalize hepatic vein in patients with hepatic vein ostial stenosis or inferior vena cava stenting or pasty among those membranous obstruction of the vena cava is a unique opportunity in the Asia–Pacific region to restore hepatic outflow closely mimicking physiology. In order to address these issues arising out of the diversity as well as the unique features in the region, the Asia Pacific Association for Study of Liver has formulated these guidelines for clinicians.

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Authors and Affiliations

  1. Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India

    Akash Shukla, Masayoshi Kage & Suprabhat Giri

  2. Alka Hospital, Kathmandu, Nepal

    Ananta Shreshtha

  3. Institute of Liver and Biliary Sciences, New Delhi, India

    Amar Mukund, Chhagan Bihari & Shiv Kumar Sarin

  4. Christian Medical College, Vellore, India

    C. E. Eapen

  5. Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China

    Guohong Han

  6. Dean and Head of Radiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India

    Hemant Deshmukh

  7. Institute of Digestive and Liver Diseases, St Lukes Medical Center, Global City, Philippines

    Ian Homer Y. Cua

  8. Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia

    Cosmas Rinaldi Adithya Lesmana

  9. Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia

    Cosmas Rinaldi Adithya Lesmana

  10. Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

    Mamun Al Meshtab

  11. Center for Innovative Cancer Therapy, Kurume University Research, 67 Asahi-machi, Kurume, 830-0011, Japan

    Mamun Al Meshtab

  12. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Roongruedee Chaiteeraki & Sombat Treeprasertsuk

  13. Vascular and Interventional Radiology, Tan Tock Seng Hospital, Singapore, Singapore

    Sundeep Punamiya

  14. Dpt dAnatomie Pathologique, Hôpital Beaujon, 100 bd du Gal Leclerc, Clichy, 92110, France

    Valerie Paradis

  15. General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, China

    Xingshun Qi

  16. Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan

    Yasuhiko Sugawara

  17. Department of Hepatogastroenterology, Dr. Ziauddin University Hospital Clifton, Karachi, Pakistan

    Zaigham Abbas

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Shukla, A., Shreshtha, A., Mukund, A. et al. Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 15, 531–567 (2021). https://doi.org/10.1007/s12072-021-10189-4

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