A Case of Reoperation for Budd-Chiari Syndrome after the Occlusion of a Cavoatrial Bypass Graft

A 42-year-old man with Budd-Chiari syndrome was admitted to our institute for reoperation. The patient had undergone a cavoatrial bypass 9 years previously, but early occlusion of the bypass graft was suspected as there was reappearance of dilated abdominal veins. Preoperative cavography showed occlusion of the bypass graft and well-developed collateral veins. The patient underwent direct reconstruction with endo-venectomy and patch angioplasty of the obstructed vena cava and hepatic veins using a ringed ePTFE graft. The markedly dilated tortuous subcutaneous veins of abdominal wall disappeared immediately after reoperation. Postoperative cavography showed the patency of the IVC and three hepatic veins, IVC-right atrium mean pressure gradient decreased from 16mmHg to 6.5mmHg. Direct reconstruction should be the first choice in surgical treatment for Budd-Chiari syndrome, and is also useful as a reoperative procedure.