Compensation by collateral circulation determines invasive therapeutic indications for patients with Budd-Chiari syndrome

We read with interest the comprehensive review article by Rossle and Gerbes that details the management of ascites in patients with liver cirrhosis and concludes that the transjugular intrahepatic portosystemic shunt (TIPS) could manage refractory ascites more effectively than large-volume paracentesis.1 However, there is an important issue regarding the management of ascites, which is caused by Budd-Chiari syndrome (B-CS), that the authors failed to address. In patients with chronic course, the formation of intra and extrahepatic collaterals leads to improvement of liver function and may silence this disease and make it asymptomatic.2 Thus, collateral circulation …