Karim, Saima; Lucas, Victor; Verma, Anil; Girgrah, Nigel; Ramee, Stephen
BACKGROUND: A 64-year-old male with Budd-Chiari syndrome (BCS) due to inferior vena cava (IVC) occlusion after liver transplant presented with massive ascites and lower extremity oedema.; INVESTIGATION: A computed tomography venogram (CTV) of the abdomen and pelvis was performed after work-up including venous ultrasound could not identify the aetiology of the oedema.; DIAGNOSIS: The patient was found to have chronic total occlusion (CTO) of the suprahepatic IVC with thrombosis in the hepatic, renal, and iliac veins and the infrahepatic IVC.; MANAGEMENT: Venography of the IVC along with catheter directed thrombolysis were performed on the first day. Subsequently, a transseptal needle was used to transverse the occlusion. A snare was used from the IVC to retract a guide-wire cranially through the tract. The lesion in the IVC was then dilated and stented with the help of IVUS.