Hepatic venography & venoplasty
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The Inferiro vena cava gram reveals indentation of the IVC by the enlarged caudate lobe.
There is no stenosis/ occlusion of the Inferior vena cava. The hepatic veins are occluded. Injection into the right hepatic vein reveals the spider web pattern with intrahepatic collateralisation.
The right hepatic vein was successfully cannulated and baloon angiopasty done. Serial baloon angioplasties were done in the RHV and a 40mmx8mm self expanding Stent was placed - Zilverex- COOK.
Although the stent is not in the ideal position; the pressure gradient fell from 25 to 12mm Hg.
On serial follow up the patient is doing well. There is complete regression of ascitis and a patent right hepatic vein.