Venous Chimney Procedure: A Novel Technical Solution to Prevent Iatrogenic Budd–Chiari Syndrome Following Retrohepatic Vena Cava Injury

Abstract

Retro hepatic IVC injuries (RHVCI) are extremely rare and lethal. The open surgical technique of treating these injuries is a master skill which is not available for most surgeons taking care of these patients. The endovascular trauma management (EVTM) application dictates a new approach in some cases based on applying arterial treatment concepts to the venous trauma cases. We hereby describe a novel technique in which the known chimney technique, often used to treat juxta renal abdominal aortic aneurysm, was used to prevent iatrogenic Budd Chiary which might have been caused by hepatic veins drainage occlusion by a Stent Graft (SG) that was inserted to treat RHVCI. Care should be taken to prevent secondary cardiac injury by long SG.

Keywords

• Penetrating Injury
• Retrohepatic Vena Cava
• Hepatic Veins
• Endovascular Treatment
• Stenting