Interventional management of benign obstruction of the hepatic inferior vena cava

The effectiveness of interventional treatment of benign obstruction of the hepatic segment of the inferior vena cava (IVC) was evaluated in a retrospective analysis.

Among 21 patients, 14 obstructions were membranous (type 1) and seven were segmental (type 2). IVC thrombosis was found proximal to the obstruction in five patients. Percutaneous transluminal angioplasty (PTA) was attempted in patients with type 1 obstruction with use of a double balloon technique in most cases (12 of 14 cases). For six of the seven patients with type 2 obstruction, metallic stent placement and PTA were performed with or without urokinase thrombolysis or percutaneous aspiration thrombectomy. Follow-up evaluation was performed with vena cavography, pressure measurement, and liver function tests.

The overall initial success rate was 95% (20 of 21 cases). The mean pressure gradient across the obstruction decreased significantly from 14.1 mm Hg +/- 4.1 to 4.2 mm Hg +/- 3.7 (P < .01) in 10 patients with type 1 obstruction and from 15.7 mm Hg +/- 3.1 to 6.0 mm Hg +/- 3.3 (P < .05) in six patients with type 2 obstructions. During the follow-up period from 6 months to 6 years, patency was maintained in nine of 10 patients with type 1 obstruction. Among the seven patients with type 2 obstruction, restenosis developed in two. Intimal thickening inside the metallic stent was found on the follow-up vena cavogram for all six patients who underwent stent placement.

For the interventional treatment of benign obstruction of the hepatic IVC, PTA with the double balloon technique is effective for the membranous type (type 1), and combined interventions including PTA, thrombolysis with urokinase, percutaneous aspiration thrombectomy, and metallic stent placements seem effective in the treatment of the segmental type (type 2). The long-term effects, including intimal thickening in cases involving the use of metallic stents, warrant further investigation.