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Eduardo Medronha: DIPS as a Rescue Strategy in Budd–Chiari Syndrome

Eduardo Medronha/LinkedIn

Aug 14, 2026, 13:28

Eduardo Medronha: DIPS as a Rescue Strategy in Budd–Chiari Syndrome

Eduardo Medronha, Interventional Radiologist and Interventional Oncologist at IntervIR at IntervIR, shared a post on LinkedIn:

”DIPS as a rescue strategy in Budd-Chiari syndrome – a challenging case

Sharing a case that highlights a technical alternative worth keeping in mind when hepatic vein access fails in Budd-Chiari syndrome.

Clinical context:

A patient with Budd-Chiari syndrome, previously treated with TIPS and with several years of well-controlled ascites, presented with recurrent symptoms. Stent evaluation confirmed the existing shunt remained patent, and a second, parallel shunt was indicated to optimize portal decompression.

Technical challenge:

Hepatic vein catheterization was not feasible due to thrombosis-a recognized limitation of conventional TIPS in Budd-Chiari syndrome, where the hepatic veins are frequently the primary site of disease.

Approach:

A DIPS (direct intrahepatic portosystemic shunt) was performed as a rescue strategy: a single percutaneous puncture with a Chiba needle traversed both the portal vein and the retrohepatic inferior vena cava directly, the guidewire was captured within the vena cava, and the shunt was created along this direct portal-caval tract-circumventing the thrombosed hepatic veins.

Why this matters:

DIPS is a well-described but underused technique for patients in whom hepatic vein access is anatomically or technically unfeasible-particularly relevant in Budd-Chiari syndrome, where venous occlusion is often the rule rather than the exception.

Having this approach in the technical repertoire can be the difference between completing portal decompression and abandoning the procedure.

Open to hearing how others have approached hepatic vein access failure in Budd-Chiari syndrome–DIPS, transcaval approaches, or other strategies.”

Eduardo Medronha: DIPS as a Rescue Strategy in Budd–Chiari Syndrome