We report the approach to a 29 year old patient presenting with the diagnosis of a Budd-Chiari Syndrome, with clinical deterioration after initial anticoagulation treatment. The patient was proposed to endovascular treatment. Through intra-hepatic shunting seen at angiography, and from a left to right liver lobe, a guide-wire was passed retrogadely and allowed sufficient support to perform hepatic vein angioplasty and stenting. The patient responded favourably and liver transplant was avoided.