Figure 1 Hepatic vein recanalisation by combined transhepatic/transjugular procedure. Long patent segment of hepatic vein seen on ultrasound, amenable to recanalisation (A). Dilated obstructed hepatic venous segment seen on percutaneous transhepatic venogram with filling of intrahepatic collateral veins (B). Percutaneous transhepatic route used to pass a thin catheter and guidewire across hepatic vein block (C) and to pass a catheter into the inferior vena cava (IVC). Note transjugular catheter in the IVC. The transhepatic wire is snared in the IVC and brought up out through the jugular vein sheath. Hepatic venogram after transjugular balloon dilatation of the hepatic venous stenosis still shows relative obstruction (D). Normal flow of contrast from hepatic vein into the IVC after transjugular stenting of hepatic vein stenosis (E). I, catheter in IVC; P, percutaneous transhepatic catheter; T, transjugular transhepatic guidewire.