PMC10031605_01
Coronal post-contrast CT of the abdomen demonstrating extensive thrombosis of
the inferior vena cava (white star), bilateral common iliac, and renal veins
along with hepatic congestion.
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Computed tomography (CT) abdominal scan showed thrombi in the middle and right intrahepatic veins and in the IVC involving bilateral renal and external iliac veins (Figure 1).
Axial post-contrast CT at the level of the liver demonstrating calcification
around a narrowed non-enhancing intrahepatic IVC (black arrow) and
ascites.
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Moderate volume ascites was also present (Figure 2).
Coronal post-contrast CT abdominal scan post-stenting of the inferior vena
cava with thrombus within the stent (short arrow). Infrarenal IVC filter is
also present (long arrow). Near complete resolution of ascites and reduction
in extent of the IVC thrombosis.
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Stent, Boston Scientific, USA) in the area of narrowed retrohepatic IVC (Figure 3). Subsequently, the shunting procedure consisted of combined percutaneous transhepatic and transjugular techniques for accessing the portal and systemic systems, respectively.
Serial coronal images demonstrating the Viatorr stent uncovered component in
the right portal vein (a) extending to the bifurcation of the main portal
vein (b) and cranial end landed within an inferior vena cava stent (c).
Percutaneous transhepatic access tract into portal vein embolization with
coils and gel foam (arrow in Figure 4(a)).
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A Viatorr  (Gore, Flagstaff, AZ, USA) polytetrafluoroethylene (PTFE)-covered stent was deployed between the right portal vein and within the IVC stent with achievement of good flows through the TIPS stent into the right atrium and reduction in portosystemic gradient to 9 mmHg (Figure 4).