Simultaneous IVC/SVC Endovascular Sharp Recanalization in a Patient with Budd–Chiari Syndrome, Systemic Lupus Erythematosus, and Antiphospholipid Syndrome: A Case Report

 

Introduction: We herein report a case of BCS complicated with inferior vena cava (IVC) and in addition to pre-existing superior vena cava (SVC) stenosis that was managed by a simultaneous IVC/SVC sharp recanalization.

Case Report: A 40-year-old lady came to the clinic complaining of distended abdomen. She is a known case of antiphospholipid syndrome and systemic lupus erythematosus. Triphasic liver computed tomography showed a heterogeneous liver with nutmeg appearance and attenuation of hepatic veins with caudate hypertrophy. The suprahepatic IVC was completely occluded. Contrast enhanced CT of the chest showed a chronic complete occlusion of the left brachiocephalic vein with multiple collaterals. SVC was patent with multiple calcific foci of the wall likely related to chronic thrombosis. Through the right femoral access, inferior venacavogram was obtained which showed suprahepatic IVC complete occlusion. Then, an upper venous access was obtained through the right internal jugular vein. Followed by a venogram which showed a complete occlusion at the right brachiocephalic vein with extensive collaterals was noted. Sharp recanalization from the jugular access of the brachiocephalic vein/SVC was performed targeting the balloon within the SVC that was advanced from the azygos vein using Chiba's needle. This was followed by placing a covered stent graft. Then through the SVC approach, successful recanalization of the IVC was made using Outback reentery device, the suprahepatic IVC was successfully recanalized followed by placement of a noncovered stent in the same time.

Conclusion: Simultaneous sharp recanalization of the occluded SVC/IVC is safe and feasible with proper planning and experienced operators.

Publication History

Article published online:
14 December 2021

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