title: A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction.
abstract: Transjugular intrahepatic portosystemic shunt (TIPS) is the standard treatment of Budd-Chiari syndrome (BCS) non responsive to medical therapy. However, patients with inferior vena cava (IVC) obstruction proximal to the atrium do not benefit from TIPS and a surgical approach is mandatory. We report the case of BCS due to intrapericardial IVC obstruction. We describe a novel surgical approach using a fresh caval homograft. An attempt to balloon dilatation of the IVC obstruction was complicated by right atrial disruption with tamponade and ventricular fibrillation. Lately, the patient successfully underwent a reconstruction of the cavo-atrial continuity by the interposition of a fresh caval homograft, a novel surgical approach never described before for BCS. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement. IVC obstruction near to the atrium can be surgically approached with a new technique consisting in inferior vena cava resection and replacement with a caval homograft.
authors.affiliation: Andrea Mancuso, Luca Saverio Belli, Epatologia e Gastroenterologia, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mancuso
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Antonio Gaetano
authors.initials: AG
authors.lastname: Rampoldi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Magenta
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Luca Saverio
authors.initials: LS
authors.lastname: Belli
keywords: Budd-Chiari syndrome; Inferior vena cava; Liver transplantation; Occlusion; Surgery