A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction

Area of Science:

• Cardiovascular Surgery
• Hepatology
• Interventional Radiology

Background:

• Budd-Chiari syndrome (BCS) often requires intervention when medical therapy fails.
• Transjugular intrahepatic portosystemic shunt (TIPS) is standard for BCS but ineffective for inferior vena cava (IVC) obstruction near the atrium.
• Surgical intervention is mandatory for BCS with IVC obstruction proximal to the right atrium.

Purpose of the Study:

• To report a novel surgical approach for Budd-Chiari syndrome (BCS) with intrapericardial inferior vena cava (IVC) obstruction.
• To describe the successful use of a fresh caval homograft for cavo-atrial reconstruction in a BCS patient.

Main Methods:

• A patient with Budd-Chiari syndrome (BCS) and intrapericardial inferior vena cava (IVC) obstruction was treated.
• An initial attempt at balloon dilatation of the IVC obstruction resulted in right atrial disruption and tamponade.
• A novel surgical reconstruction was performed using a fresh caval homograft to restore cavo-atrial continuity.

Main Results:

• The novel surgical approach involving caval homograft interposition was technically successful.
• The patient experienced progressive reduction and resolution of ascites post-surgery.
• Overall clinical improvement was observed following the surgical intervention.

Conclusions:

• Inferior vena cava (IVC) obstruction near the atrium in Budd-Chiari syndrome (BCS) can be effectively managed with surgery.
• Resection and replacement of the IVC with a caval homograft represent a novel and successful surgical technique for complex BCS.
• This approach provides a viable alternative when TIPS is not an option for BCS patients with specific IVC obstruction patterns.