Transhepatic inferior vena cava recanalization in a case of Budd Chiari syndrome: A novel approach

• Published in: Radiology case reports Vol. 18; no. 11; pp. 4172 - 4175
• Main Authors: Sujanyal, Saurabh Ashok, Shah, Priyansh Parag, Willis, Joseph Gartrell, El Khudari, Husameddin, Varma, Rakesh K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2023; Elsevier
• Subjects: Budd Chiari syndrome; Case Report; Inferior vena cava occlusion; Portal Hypertension; Sharp recanalization; Transhepatic endovascular recanalization; Budd Chiari syndrome; Sharp recanalization; Portal Hypertension; Inferior vena cava occlusion; Transhepatic endovascular recanalization
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2023.08.067

Sharp recanalization for short-segment intravascular occlusion, using an endovascular route, has been described for inferior vena cava (IVC) occlusion. Often, the technical challenge to the endovascular management of Budd-Chiari syndrome (BCS) is the recanalization of the occluded hepatic vein or suprahepatic IVC. Presented here, the challenge was the level of occlusion of the suprahepatic IVC, with the resultant separation of both the patent IVC segments in a horizontal plane, making it technically challenging for sharp recanalization. We describe the use of percutaneous transhepatic access into the suprahepatic IVC via the middle hepatic vein under ultrasound guidance with eventual sharp recanalization of the occluded segment of the IVC, in a woman with BCS. This novel approach has not been described in the literature and can serve as an important addition to guide complex suprahepatic IVC recanalization.