Percutaneous Endovascular Creation of an Inferior Vena Cava in a Patient with Caval Agenesis, Budd-Chiari Syndrome, and Iliofemorocaval Thrombosis

A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd-Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a “neocava” lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up.