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Compensation by collateral circulation determines invasive therapeutic indications for patients with Budd-Chiari syndrome
  1. Yuling Sun1,
  2. Xiuxian Ma1,
  3. Liushun Feng1,
  4. Sheng Guan2,
  5. Zhiwei Wang2
  1. 1Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou, P. R. China
  2. 2Department of Radiological Intervention, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Zhengzhou, P. R. China.
  1. Correspondence to Dr Yuling Sun, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, 1 Jianshe Road, Zhengzhou 450052, P.R. China; ylsun{at}zzu.edu.cn

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We read with interest the comprehensive review article by Rössle 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 …

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