SUCCESSFUL TREATMENT BY SIMULTANEOUS HEPATIC VENOPLASTY AND CAVOPLASTY FOR BUDD-CHIARI SYNDROME WITH OBSTRUCTION OF RETROHEPATIC INFERIOR VENA-CAVA

Background. Various surgical procedures for treating chronic Budd-Chia ri syndrome have been established, but none are adequate because of th e variation in underlying pathologic vascular changes. Methods. This a rticle presents a 32-year-old patient with a 5 cm long segment of obst ruction of the retrohepatic inferior vena cava involving the main hepa tic veins with severe portal hypertension. Results. After five unsucce ssful attempts at percutaneous transluminal angioplasty, simultaneous hepatic venoplasty was conducted with the saphenous vein patch and ret rohepatic inferior venacavoplasty by the expanded polytetrafluoroethyl ene patch with a 3 cm long cuff interposition for suprahepatic reconst ruction of the inferior vena cava. Hypothermic preserved liver perfusi on after vascular isolation and femoroportoaxillary venovenous bypass with a centrifugal blood pump throughout the anhepatic stage ensured s afe operation on the liver and maintained hemodynamics. Early postoper ative anticoagulant is recommended. Conclusions. An uneventful Postope rative course and a 10-month follow-up showing excellent condition ind icated this one-stage simultaneous patch hepatic venoplasty and cavopl asty to be adequate for appropriate correction very of complex obstruc tive vascular lesions in Budd-Chiari syndrome.