Case Report
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World J Hepatol. May 27, 2013; 5(5): 292-295
Published online May 27, 2013. doi: 10.4254/wjh.v5.i5.292
A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction
Andrea Mancuso, Luigi Martinelli, Luciano De Carlis, Antonio Gaetano Rampoldi, Giovanni Magenta, Aldo Cannata, Luca Saverio Belli
Andrea Mancuso, Luca Saverio Belli, Epatologia e Gastroenterologia, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
Luigi Martinelli, Aldo Cannata, Cardiochirurgia, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
Luciano De Carlis, Chirurgia Generale e dei Trapianti, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
Antonio Gaetano Rampoldi, Radiologia Interventistica, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
Giovanni Magenta, Cardiologia 3, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
Author contributions: Mancuso A designed research, performed research, contributed new reagents or analytic tools, analyzed data and wrote the paper; Martinelli L, De Carlis L, Rampoldi AG, Magenta G, Cannata A and Belli LS analyzed data.
Correspondence to: Andrea Mancuso, MD, Epatologia e Gastroenterologia, Ospedale Niguarda Ca’ Granda, Piazza Maggiore 3, 20162 Milano, Italy. andrea.mancuso@ospedaleniguarda.it
Telephone: +39-2-64444435 Fax: +39-2-64442895
Received: February 13, 2013
Revised: March 28, 2013
Accepted: May 8, 2013
Published online: May 27, 2013
Processing time: 103 Days and 11.8 Hours
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.

Keywords: Budd-Chiari syndrome; Inferior vena cava; Occlusion; Surgery; Liver transplantation

Core tip: We describe a novel surgical approach using a fresh caval homograft for inferior vena cava (IVC) obstruction proximal to the atrium. 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 Budd-Chiari syndrome. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement.