Ilahe Abdurahmanova1, Elnur Alizade2

1Ministry Of Emergency Situation Of The Republic Of Azerbaijan/ Medical Center, Kardiyoloji, Bakü, Azerbaijan
2Kartal Kosuyolu Heart Research And Training Hospital, Kardiyoloji, Istanbul, Turkey

Keywords: budd-chiari, endovascular treatment

Abstract

50 years old male patient was transferred our outpatient clinic diagnosis of Budd-Chiari Syndrome(BCS) due to Essential Thrombocytosis from oncology clinic. Abdominal Doppler ultrasonography(USG) examination revealed increases of portal vein diameter, compression of main hepatic veins(HVs) and massive ascites. Magnetic resonance imaging(MRI) confirmed the ultrasound findings with infra-hepatic inferior vena cava(IVC) dilatation and severe stenosis of IVC. IVC and HVs angiography was performed using 6 Fr pigtail and right Judkins catheters via a transfemoral and transjugular approaches, respectively. An angiography showed significant stenosis of IVC and complete obstruction of HVs. After progressive balloon dilatation of HVs with 2.5*20 mm/3.0*20 mm, balloon angioplasty(18 mm in diameter) at the obstructed IVC segment was performed followed by self-expandable stent(40x24 mm diameter Wallstent, Boston Scientific, Marlborough, Mass) placement. After dilatation of the stenotic segment by stent expansion and angioplasty of HVs, IVC venography revealed restored normal flow through the IVC into the right atrium. Five month after percutaneous treatment, abdominal distension disappeared with normal waveform/colour flow by Doppler USG and follow-up MRI scan of the abdomen showed a patent IVC and HVs. Percutaneous treatment of IVC stenosis is safety, feasible and effective alternative procedure to surgery in carefully selected and high surgical risk BCS patients.