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By Richard Taus, MD; E-mail rtaus@challiance.org ..read more

By Richard Taus, MD; E-mail rtaus@challiance.org ..read more

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A 42-year-old woman from an underprivileged rural area presented with gradually increasing ascites and slightly elevated bilirubin level (1.9 mg/dL; normal, ≤1.1 mg/ dL). On further evaluation, the patient was diagnosed with chronic Budd-Chiari syndrome (BCS) with occluded hepatic veins and portal hypertension. Because there were no recanalizable hepatic veins, a direct intrahepatic portosystemic shunt (DIPS) was created using a 10-mm stent (Fig 1a). The patient was discharged on oral warfarin (3 mg/d), with an international normalized ratio (INR) target range between 2 and 3 ..read more