Complete membranous obstruction of the inferior vena cava: clinical characteristics of Chinese patients.

Abstract

OBJECTIVES: To analyse the clinical presentations of membranous-type Budd-Chiari syndrome and the long-term outcome of balloon angioplasty. DESIGN: A case-control study. Patients who received abdominal sonography and were suspected of having hepatic venous outflow obstruction were advised to receive cardiac catheterization and angiography. SETTING: Patients were collected from Chung Hisao Hospital and Chang Gung Medical Centre. Angioplasty was done at Chang Gung Medical Centre. SUBJECTS: Seventeen patients who had the symptoms and signs of portal hypertension were suspected of having hepatic venous outflow obstruction after abdominal sonography and a radionuclide liver scan and eight of them were confirmed as having membranous-type obstruction. INTERVENTIONS: Simultaneous catheterization and contrast angiography was performed via the right brachial and femoral veins. Angioplasty was performed afterwards. MAIN OUTCOME MEASURES: The remission of clinical symptoms and signs and a decrease of the pressure gradient between the right atrium and inferior vena cava were used as indicators of successful intervention. RESULTS: All patients had remarkable remission of symptoms and signs. The average pressure gradient between right atrium and inferior vena cava dropped from 16.5 +/- 1.6 to 6.5 +/- 1 mmHg (mean +/- SD). CONCLUSION: The clinical presentations of membranous-type Budd-Chiari syndrome are somewhat different from hepatic vein occlusion. Balloon angioplasty may be a modality for curing this disease. A larger patient population is necessary to confirm this study.