Combination of thrombolytic therapy and angioplastic stent insertion in a patient with Budd-Chiari syndrome.
A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava (lVC). Thrombolytic therapy with systemic streptokinase (250000 IU loading + 100000 IU/h infusion) was started. At the end of 72 h infusion, the patient's general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the lVC. Percutaneous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.
Reza
Fatemi
F
Gastrointestinal & Liver Diseases Research Center, Fatemieh Hospital, 17th Shahrivar Avenue, Semnan, Iran. nedafat20@yahoo.com
Naser
Daryani E
DE
Hossein
Ganaati
G
Mehrdad
Zahmatkesh
Z
D000328:Adult; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D006502:Budd-Chiari Syndrome / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010690:Phlebography; D015607:Stents; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014682:Vena Cava, Inferior / Q000473:pathology
D005343:Fibrinolytic Agents; D013300:Streptokinase