title: Inferior vena cava bypass for the treatment of obliterative hepatocavopathy with five-year follow-up.
abstract: Inferior vena cava (IVC) thrombosis at its hepatic portion (also known as obliterative hepatocavopathy [OH]), in the absence of systemic or local diseases such as vasculitis, coagulopathy, infection and malignancy, is a rare event. We report the case of a 25-year-old woman with progressive abdominal pain and leg edema after exercise. Imaging showed congestive liver and IVC occlusion at the intrahepatic portion. A liver biopsy demonstrated portal congestion without evidence of fibrosis; after unsuccessful percutaneous attempts for recanalization, consideration was given to liver transplantation with IVC reconstruction versus IVC bypass. Due to the presence of preserved liver function, an externally supported 16-mm ringed polytetrafluoroethylene graft was used to bypass from the suprarenal IVC to the suprahepatic IVC. At five years, she remains symptom-free, with normal liver function and a patent graft on systemic anticoagulation. This report highlights the successful surgical management of a patient with OH with a thick membrane. It supports other published proposals that this entity differs significantly from classic Budd-Chiari syndrome with thrombosis that affects only the hepatic veins and, thus, OH should be approached and managed differently.
authors.affiliation: Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center and The Methodist Hospital Research Institute, The Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030,  USA.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: Brett A
authors.initials: BA
authors.lastname: Johnson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smolock
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D014057:Tomography, X-Ray Computed; D058017:Vascular Grafting / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*