title: Inferior vena cava obstruction: long-term results of endovascular management.
abstract: BACKGROUND
  Hepatic venous outflow obstruction (HVOO) can have acute or chronic presentation. In the chronic variety of inferior vena cava (IVC) obstruction, endovascular management with balloon angioplasty and stent implantation has emerged as a feasible, safe alternative to surgery which has high incidence of mortality and morbidity.
  
  
  OBJECTIVE
  To study the feasibility and long-term follow-up of endovascular management of chronic IVC obstruction.
  
  
  METHODS
  We studied 12 cases of HVOO who underwent endovascular management (balloon dilatation ± stenting). In most of the cases, the cause of obstruction was not obvious, but one case had metastatic hepatic nodules compressing on IVC. Diagnosis was established by clinical examination, venous Doppler and was confirmed by venography and/or computed tomography (CT) angiography. Cases underwent balloon dilatation and/or stenting.
  
  
  RESULTS
  Out of 12 cases, six had membranous obstruction (four complete and two incomplete), five cases had segmental stenosis and one case had tumour compression. The lesion was crossed with either guide wire or Brockenbrough needle with Mullins sheath assembly and balloon dilatation was done with Inoue or Mansfield balloon. Seven cases underwent balloon dilatation alone while five cases underwent stenting. There was procedural success in all cases with reduction of gradient by 84%, disappearance of collaterals and clinical improvement. During the follow-up of 13 years, one case had restenosis, which was managed by stenting.
  
  
  CONCLUSIONS
  Endovascular management of IVC obstruction is safe with good long-term patency rates.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India. lotusheart7@gmail.com
authors.forename: B C
authors.initials: BC
authors.lastname: Srinivas
authors.forename: P V
authors.initials: PV
authors.lastname: Dattatreya
authors.forename: K H
authors.initials: KH
authors.lastname: Srinivasa
authors.lastname: Prabhavathi
authors.forename: C N
authors.initials: CN
authors.lastname: Manjunath
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D006502:Budd-Chiari Syndrome / Q000628:therapy; D002908:Chronic Disease; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases; D014682:Vena Cava, Inferior