Two-step procedure in Budd-Chiari syndrome with severe intrahepatic vena cava stenosis: vena cava stenting and portocaval shunt.
Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Venous decompressive shunt surgery and liver transplantation represent efficient surgical treatments of Budd-Chiari syndrome. In the case presented here, severe intrahepatic compression of the inferior vena cava (IVC) was caused by the hypertrophic caudate lobe. A mere portocaval shunt was not feasible because of a large pressure gradient across the intrahepatic stenosis. A two-step procedure with preoperative radiological dilation and stenting of the intrahepatic IVC followed by a portocaval shunt was successfully performed. Consequently, liver transplantation and its subsequent immunosuppression could be avoided.
Division of Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
K J
KJ
Oldhafer
M
M
Frerker
M
M
Prokop
H
H
Lang
K
K
Böker
R
R
Pichlmayr
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000601:surgery / Q000628:therapy*; D002404:Catheterization; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000628:therapy; D006984:Hypertrophy; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000628:therapy; D016031:Liver Transplantation; D008642:Mesenteric Veins / Q000601:surgery; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery; D015607:Stents; D017131:Thrombectomy; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery