Stent Placement for Idiopathic Obstruction of the Inferior Vena Cava

Abstract

Ten patients (mean age 36.6 ± 8 years; 5 male) with idiopathic inferior vena cava obstruction underwent balloon angioplasty, followed by placement of a self-expanding stent. Six had total occlusion, 5 had restenosis (including 2 with total occlusion), and I had a suboptimal result after initial dilatation. The mean diameter of the inferior vena cava increased from 1.5 ± 2.1 mm to 14.4 ± 2.7 mm, and the pressure gradient between the vena cava and the right atrium decreased from 15.2 ± 5.0 mm Hg to 1.1 ± 1.5 mm Hg. Follow-up venography after 74 ± 35 days in 6 patients, revealed ho restenosis, with further enlargement of the mean diameter by 5.2 ± 3.1 mm (44 ± 35%) and abolition of pressure gradients. One patient died 6 months after the procedure from acute Budd-Chiari syndrome. Autopsy revealed a widely patent stent with hepatic vein thrombus. Stent implantation is useful in the management of inferior vena cava obstruction with prior restenosis, total occlusion, or suboptimal results of balloon angioplasty.