Percutaneous balloon angioplasty in membranous obstruction of inferior vena cava with massive thrombi: A case report

We report the successful treatment of Budd-Chiari syndrome caused by membranous obstruction of intrahepatic inferior vena cava (MOVC) with large amount of thrombi by balloon angioplasty. A 45-year-old woman developed general malaise and edema of legs. MOVC with large thrombi was diagnosed after MR angiogram and vena cavogram. We performed two-stage percutaneous transluminal angioplasty (PTA) with anticoagulant therapy. This strategy brought about interval resolution of thrombi and prevented the potential complication of massive pulmonary embolism. The first PTA was carried out with an 8 mm balloon catheter tailored for creation of substantial patency with forward flow of inferior vena cava (IVC) and yet to avoid massive pulmonary arterial embolization. The symptoms and signs got improved after the first PTA. The second PTA was performed with an 18 mm balloon catheter four months later, at which time only minimal residual thrombi retained.