BACKGROUND: Hepatic venous outflow obstruction (HVOO) can have acute or chronic presentation. In the chronic variety of inferior vena cava (IVC) obstruction, endovascular management with balloon angioplasty and stent implantation has emerged as a feasible, safe alternative to surgery which has high incidence of mortality and morbidity. AIMS AND OBJECTIVES: To study the feasibility and long-term follow-up of endovascular management of chronic IVC obstruction. METHODS: We studied 12 cases of HVOO who underwent endovascular management (balloon dilatation ± stenting). In most of the cases, the cause of obstruction was not obvious, but one case had metastatic hepatic nodules compressing on IVC. Diagnosis was established by clinical examination, venous Doppler and was confirmed by venography and/or computed tomography (CT) angiography. Cases underwent balloon dilatation and/or stenting. RESULTS: Out of 12 cases, six had membranous obstruction (four complete and two incomplete), five cases had segmental stenosis and one case had tumour compression. The lesion was crossed with either guide wire or Brockenbrough needle with Mullins sheath assembly and balloon dilatation was done with Inoue or Mansfield balloon. Seven cases underwent balloon dilatation alone while five cases underwent stenting. There was procedural success in all cases with reduction of gradient by 84%, disappearance of collaterals and clinical improvement. During the follow-up of 13 years, one case had restenosis, which was managed by stenting. CONCLUSION: Endovascular management of IVC obstruction is safe with good long-term patency rates.
BACKGROUND:Hepatic venous outflow obstruction (HVOO) can have acute or chronic presentation. In the chronic variety of inferior vena cava (IVC) obstruction, endovascular management with balloon angioplasty and stent implantation has emerged as a feasible, safe alternative to surgery which has high incidence of mortality and morbidity. AIMS AND OBJECTIVES: To study the feasibility and long-term follow-up of endovascular management of chronic IVC obstruction. METHODS: We studied 12 cases of HVOO who underwent endovascular management (balloon dilatation ± stenting). In most of the cases, the cause of obstruction was not obvious, but one case had metastatic hepatic nodules compressing on IVC. Diagnosis was established by clinical examination, venous Doppler and was confirmed by venography and/or computed tomography (CT) angiography. Cases underwent balloon dilatation and/or stenting. RESULTS: Out of 12 cases, six had membranous obstruction (four complete and two incomplete), five cases had segmental stenosis and one case had tumour compression. The lesion was crossed with either guide wire or Brockenbrough needle with Mullins sheath assembly and balloon dilatation was done with Inoue or Mansfield balloon. Seven cases underwent balloon dilatation alone while five cases underwent stenting. There was procedural success in all cases with reduction of gradient by 84%, disappearance of collaterals and clinical improvement. During the follow-up of 13 years, one case had restenosis, which was managed by stenting. CONCLUSION: Endovascular management of IVC obstruction is safe with good long-term patency rates.
Authors: V Singh; S K Sinha; C K Nain; P Bambery; U Kaur; S Verma; Y K Chawla; K Singh Journal: J Gastroenterol Hepatol Date: 2000-05 Impact factor: 4.029
Authors: S Furui; S Sawada; T Irie; K Makita; T Yamauchi; S Kusano; K Ibukuro; H Nakamura; E Takenaka Journal: Radiology Date: 1990-09 Impact factor: 11.105
Authors: Andrea Mancuso; Luigi Martinelli; Luciano De Carlis; Antonio Gaetano Rampoldi; Giovanni Magenta; Aldo Cannata; Luca Saverio Belli Journal: World J Hepatol Date: 2013-05-27
Authors: Rick de Graaf; Mark de Wolf; Anna M Sailer; Jorinde van Laanen; Cees Wittens; Houman Jalaie Journal: Cardiovasc Intervent Radiol Date: 2015-03-14 Impact factor: 2.740