Management of idiopathic obstruction of the hepatic and suprahepatic inferior vena cava with a self-expanding metallic stent.

Abstract

Ten patients (median age 36 yr, 5 male) with idiopathic IVC obstruction underwent balloon angioplasty followed by placement of a self-expanding stent due to unfavourable lesion characteristics. Six had total occlusion, 5 had restenosis (including 2 with total occlusion), and 1 had a suboptimal result after initial dilatation. Median minimum IVC diameter increased from 0 to 14.5 mm, and the median gradient across the lesion decreased from 16.5 to 1 mmHg. Follow-up venography (median interval 69 d) in six patients revealed no restenosis with further enlargement at the lesion site (median 4.5 mm) and abolition of gradients. Follow-up ultrasound in nine patients revealed no restenosis in the IVC. One patient died 6 mo after the procedure with acute Budd-Chiari syndrome due to hepatic vein occlusion. Autopsy revealed a widely patent stent with hepatic vein thrombus. Stent implantation is useful in the management of IVC obstruction with prior restenosis, total occlusion, or suboptimal result of balloon angioplasty.