Sharp Recanalization of the Hepatic Vein Using a Chiba Needle in Budd–Chiari Syndrome

Abstract Hepatic vein recanalization in Budd–Chiari syndrome may require procedural modification if the endovascular approach fails. Sharp recanalization using the stiff end of a guidewire or a thin Chiba needle remains an effective technique in difficult-to-cross hepatic vein stricture. Of note, this technique requires utmost precaution to avoid catastrophic hemorrhage. The present case describes the successful recanalization of the middle hepatic vein using a 21-gauge Chiba needle through the percutaneous transhepatic route.