Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome
Restricted accessCase reportFirst published online July, 2021
Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome
Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.
Rivers-BowermanMDLightfootCBMeagherRPCarterMDBerryRF. Percutaneous sharp recanalization of a membranous IVC occlusion with an occlusion balloon as a needle target. Radiol Case Rep. 2017;12(3):537–541.
2.
FerralHBehrensGLoperaJ. Budd-Chiari syndrome. AJR Am J Roentgenol. 2012;199(4):737–745.
3.
SonavaneADAmarapurkarDNRathodKRPunamiyaSJ. Long term survival of patients undergoing tips in Budd-Chiari syndrome. J Clin Exp Hepatol. 2019;9(1):56–61.
4.
OlliffSP. Transjugular intrahepatic portosystemic shunt in the management of Budd Chiari syndrome. Eur J Gastroenterol Hepatol. 2006;18(11):1151–1154.
5.
RosenqvistKSheikhiRErikssonLG, et al.Endovascular treatment of symptomatic Budd-Chiari syndrome—in favour of early transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol. 2016;28(6):656–660.
6.
TurnesJGarcía-PagánJCGonzález-AbraldesJ, et al.Stenosis of the suprahepatic inferior vena cava as a complication of transjugular intrahepatic portosystemic shunt in Budd-Chiari patients. Liver Transpl. 2001;7(7):649–651.
7.
CarnevaleFCSzejnfeldDMoreiraAM, et al.Long-term follow-up after successful transjugular intrahepatic portosystemic shunt placement in a pediatric patient with Budd-Chiari syndrome. Cardiovasc Intervent Radiol. 2008;31(6):1244–1248.
8.
WilsonMWGordonRLLaBergeJM, et al.Liver transplantation complicated by malpositioned transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 1995;6(5):695–699.
9.
TsauoJYuYLuoX, et al.Direct intrahepatic portocaval shunt creation via the inter-strut space of the inferior vena cava stent. Clin Radiol. 2014;69(9):896–899.
10.
AhmedMKeshavaSNMosesV, et al.Transjugular intrahepatic portosystemic shunt through the strut of a previously placed stent: technical feasibility and long-term follow-up results. Cardiovasc Intervent Radiol. 2018;41(11):1794–1798.
