İlahe Abdurahmanova1, Elnur Alizade2

1Department of Cardiology, Ministry of Emergency Situation of The Republic of Azerbaijan, Medical Center, Baku, Azerbaijan
2Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey

Fifty years old male patient was transferred our outpatient clinic diagnosis of BuddChiari syndrome (BCS) due to essential thrombocytosis from oncology clinic. Abdominal doppler ultrasonography (USG) examination revealed increases of portal vein diameter (Figure 1A), compression of main hepatic veins (HVs) and massive ascites (Figure 1B). Magnetic resonance imaging (MRI) confirmed the ultrasound findings with infra-hepatic inferior vena cava (IVC) dilatation and severe stenosis of IVC (Figure 1C). 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 (Figure 2A). After progressive balloon dilatation of HVs with 2.5 x 20 mm/3.0 x 20 mm (Figure 2B), balloon angioplasty (18 mm in diameter) at the obstructed IVC segment was performed followed by self-expandable stent (40 x 24 mm diameter Wallstent, Boston Scientific, Marlborough, Mass) placement (Figure 2C). After dilatation of the stenotic segment by stent expansion and angioplasty of HVs (Figure 2D), IVC venography revealed restored normal flow through the IVC into the right atrium (Figure 2E). 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 (Figure 2F). Percutaneous treatment of IVC stenosis is safety, feasible and effective alternative procedure to surgery in carefully selected and high surgical risk BCS patients.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - İA, EA; Analysis and Interpretation - İA, EA; Data Collection - İA, EA; Writing - İA, EA; Critical Revision - İA, EA; Overall Responsibility - İA, EA; Final Approval - İA, EA.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declare that this study has received no financial support.

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