PMC5081419_01
(A) left lobe venography showing a permeable left hepatic vein (slim arrow), with intrahepatic collaterals (arrowhead). (B) continuing injection of contraste shows that the oppacification of intrahepatic collaterals is followed by oppacification of a right lower hepatic vein (fat arrowhead). Dotted line shows the orientation of the oppacification during injection. (C) Nitinol guidewire passed through from the left to right lower hepatic vein. Arrowheads in dotted line shows the path taken by the wire. (D) fat arrow indicates deployed stent in the previously stenotic hepatic vein confluence.
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Reverse portography was performed, with opacification of intrahepatic shunts. (Fig. 1A). A guidewire was progressed through intrahepatic shunts from the left to the right lobe where a variant double right hepatic vein was seen. (Fig. 1B) Despite the occluding thrombosis, it was possible to pass a guidewire retrogadely to the inferior vena cava by the lower right hepatic vein (Fig. 1C). This allowed sufficient support for placing two stent (14 x 40 mm, Zilverflex Cook ). (Fig. 1D) Baloon angioplasty was also performed on the left hepatic vein at the convergence with the inferior vena cava.