Inferior vena cava obstruction in Budd-Chiari syndrome: successful treatment by radiological stenting followed by a portosystemic shunt

Surgical decompression by a portosystemic shunt in Budd-Chiari syndrome dep ends on the caval state. Obstruction of the inferior vena cava (IVC) preclu des such an operation due to the risk of reduced blood flow across the shun t and subsequent thrombosis. Similar risks are encountered in more complica ted operations such as mesoatrial shunt, We report a patient with Budd-Chia ri syndrome in whom obstruction of the intrahepatic IVC by a hypertrophied caudate lobe of the liver precluded the construction of a standard portocav al shunt. A two-step procedure with preoperative radiological stenting of t he narrowed IVC followed by a portocaval shunt was successfully performed. This is the fifth case reported in the literature of such an approach, for J Gastroenterol Hepatol 13:275-277 (C) 2001 Lippincott Williams & Wilkins.