Fig. 1.

Recanalization of occluded intrahepatic portosystemic covered stent in a 41-year-old patient with Budd-Chiari syndrome where the transjugular approach was not feasible. A Transfemoral insertion of a reverse-curve catheter (5 Fr Simmons 1 catheter; Cordis) into the right liver-vein ostium. A hydrophilic guide wire (Terumo, Japan) was used to cross the occlusion, while maintaining tension on the catheter to ensure support while manipulating the wire through the occlusion. B Next, PTA was performed using a 4 mm balloon via the femoral access, which then C enabled transjugular insertion of a 4 Fr Vertebralis catheter into the TIPS/portal system; which had not been possible before. D Post-procedure portal venogram shows the restoration of the shunt function after balloon angioplasty and implantation of an additional stent-graft