Hepatic venous outflow block caused by short-length hepatic vein stenoses.
In contrast with the well-recognized membranous obstruction of the inferior vena cava, short-length hepatic vein stenoses are not well-recognized causes of hepatic venous outflow block. The aim of this study was to ascertain the prevalence, causes, manifestations, and outcome of short-length hepatic vein stenoses. We performed a retrospective study of patients with short-length hepatic vein stenosis among 86 patients with hepatic venous outflow block who were seen between 1970 and 1992. There were 25 patients with short-length hepatic vein stenosis. A thrombogenic condition was identified in 14 patients (56%). The lesions of the accompanying hepatic veins in these patients were variable (short-length stenoses, thromboses, or nonspecific changes) and similar to that seen in patients without short-length hepatic vein stenosis. In 3 necropsied cases, the venous lesions were suggestive of fibrous sequela of prior thromboses. In patients with short-length hepatic vein stenosis, splenomegaly (28% vs. 55%, P < .05) and hypersplenism were significantly less common; serum transaminase (P < .001) and creatinine levels (P < .02) were lower, prothrombin was higher (P < .001), and 5-year survival was significantly better (Kaplan-Meier estimates: 80% vs. 50%, P < .05). In patients with hepatic venous outflow block, short-length hepatic vein stenosis is a common lesion that appears to be the sequela of localized thrombosis. Long-term anticoagulation and percutaneous angioplasty (with or without stenting) are potentially applicable in these lesions. The long-term results of these treatments merit further evaluation.
Valla
D
D
Service d'Hépatologie, Hópital Beaujon, Clichy, France.
Hadengue
A
A
el Younsi
M
M
Azar
N
N
Zeitoun
G
G
Boudet
M J
MJ
Molas
G
G
Belghiti
J
J
Erlinger
S
S
Hay
J M
JM
Benhamou
J P
JP
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D003251:Constriction, Pathologic; D005260:Female; D006503:Hepatic Veins / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000473:pathology / Q000503:physiopathology