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

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 catherization 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.