Hepatic venography (a vein X-ray) can assist in identifying the exact location of the obstruction and may also be used as a means of decompressing the liver, ideally by recanalising (reforming) the hepatic veins.
When this is not possible, shunts, including TIPSS (transjugular intrahepatic portal systemic shunt), side to side portacaval shunts and mesoatrial shunts are used to re-direct the blood from the liver back to the heart thus converting the portal vein from an inflow to an outflow vessel.
Stents may be inserted to hold veins/shunts open and ensure they remain ‘patent’ (open).
Liver transplantation may be an option where severe fibrosis and other signs implying chronic liver disease are present.
The objectives of treatment for BCS are to:
- Prevent propagation (increase) of thrombosis
- Relieve hepatic congestion
- Manage the ascites (with a low sodium diet or diuretics, for example)
- Prevent further damage to the liver and allow the cells to regenerate.