Endovascular stenting of chronic retrohepatic inferior vena cava interruption in Budd-Chiari syndrome.

Budd-Chiari syndrome is a rare cause of hepatic venous outflow obstruction, with heterogenous etiologies. We report the case of a 35-year-old man with chronic, compensated Budd-Chiari syndrome due to retrohepatic inferior vena cava (IVC) occlusion, likely resulting from early-life thrombosis. Imaging and venography confirmed a 3-cm IVC interruption with extensive alternative venous drainage. Endovascular recanalization, balloon venoplasty, and stent placement successfully restored hepatic venous outflow, leading to improvement in hepatic congestion and complete resolution of symptoms. This case highlights the importance of advanced imaging in diagnosing chronic thrombotic occlusion and demonstrates that preserved hepatic venous drainage from chronic venous rerouting may allow successful IVC recanalization/stenting without the need for transjugular intrahepatic portosystemic shunt placement.