Explanting the migrated hepatic stent in the right atrium by modified vena caval inflow occlusion

  • Manoras Mathew Chengalath
  • Thomas Mathew
  • Lijesh Kumar
  • Jose Chacko Periappuram
  • Subramanian Chellappan
  • Edwin Francis
Case Report


Stenting of hepatic veins can be a long lasting solution for Budd–Chiari syndrome. These stents could very rarely migrate into the right atrium. During surgical retrieval, cardiopulmonary bypass (CPB) can be avoided if vena caval inflow occlusion (VCIO) is used. A hybrid alternative of VCIO by using a balloon to occlude the inferior vena cava was done to retrieve the stent thus avoiding CPB and total circulatory arrest.


Cardiac surgical procedures Budd–Chiari syndrome Stent 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Not applicable.

Supplementary material

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Radiological image S1

Guide wires in the inferior vena cava and right hepatic vain. (GIF 292 kb)

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High resolution image (TIFF 846 kb)
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Radiological image S2

Dye in the inferior vena cava demonstrating the occluded intrahepatic segment. (GIF 213 kb)

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High resolution image (TIFF 478 kb)
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Radiological image S3

Balloon dilatation of the occluded segment. (GIF 359 kb)

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High resolution image (TIFF 1041 kb)
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Radiological image S4

Stent deployment in the occluded segment. (GIF 309 kb)

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High resolution image (TIFF 841 kb)
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Radiological image S5

Stent migration into the right atrial – inferior vena caval junction. (GIF 326 kb)

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High resolution image (TIFF 938 kb)
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Radiological image S6

Deployment of the second stent to pull back the migrated stent. (GIF 289 kb)

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Radiological image S7

Attempts to retrieve with the second stent and balloon. (GIF 310 kb)

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High resolution image (TIFF 840 kb)
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Radiological image S8

First stent at the RA- IVC junction. Second stent at stenotic segment of IVC (GIF 313 kb)

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High resolution image (TIFF 902 kb) (4.2 mb)
ESM S9 (MOV 4306 kb)


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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryLisie HospitalCochinIndia
  2. 2.Department of Diagnostic and Interventional RadiologyPVS Memorial HospitalCochinIndia
  3. 3.Department of Pediatric AnesthesiologyLisie HospitalCochinIndia
  4. 4.Department of Pediatric CardiologyLisie HospitalCochinIndia

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