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Inferior Vena Cava Stenting: A Safe and Effective Treatment for Intractable Ascites in Patients with Polycystic Liver Disease

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Journal of Gastrointestinal Surgery

Abstract

We performed a retrospective study of seven patients with polycystic liver disease who underwent stenting of the inferior vena cava for intractable ascites. All patients had symptomatic ascites and inferior vena cava stenosis demonstrable by venography. The mean pressure gradient across the inferior vena cava stenosis before stenting was 14.5 mm Hg (range 6–25 mm Hg) and significantly decreased to a mean pressure gradient of 2.8 mm Hg (range 0–6 mm Hg, p = 0.008) after stenting. Two patients also had stenting of hepatic venous stenoses after unsuccessful inferior vena cava stenting. After a mean follow-up of 12.2 months (range 0.5–39.1 months), five of the seven patients have had maintained clinical improvement, defined as decreased symptoms, diuretic requirements, and frequency of paracentesis. Four patients have required no further intervention. The other patient was lost in follow-up. Patients with clinical improvement had an overall larger mean pressure gradient before stenting (19.2 vs. 9.8 mm Hg) and a larger Δ pressure gradient (15.8 vs. 7.8 mm Hg) compared to those in whom stenting was unsuccessful. These results suggest inferior vena cava stenting is safe and effective and should be considered as a first-line intervention in the treatment of medically intractable ascites in select patients with polycystic liver disease.

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References

  1. Chen M-F. Surgery for adult polycystic liver disease. J Gastroenterol Hepatol 2000;15:1239–1242.

    Article  PubMed  CAS  Google Scholar 

  2. Kwok MK, Lewin KJ. Massive hepatomegaly in adult polycystic liver disease. Am J Surg Pathol 1988;12:321–324.

    Article  PubMed  CAS  Google Scholar 

  3. Milutinovic J, Fialkow PI, Rudd TG, Agodoa LY, Phillips LA, Bryant JI. Liver cysts in patients with autosomal dominant polycystic kidney disease. Am J Med 1980;68:741–744.

    Article  PubMed  CAS  Google Scholar 

  4. Chauveau D, Fakhouri F, Grunfeld J-P. Liver involvement in autosomal-dominant polycystic kidney disease: therapeutic dilemma. J Am Soc Nephrol 2000;11:1767–1775.

    PubMed  CAS  Google Scholar 

  5. Starzl TE, Reyes J, Tzakis A, Mieles L, Todo S, Gordon R. Liver transplantation for polycystic liver disease. Arch Surg 1990;125:575–577.

    PubMed  CAS  Google Scholar 

  6. Swenson K, Seu P, Kinkhabwala M, Maggard M, Martin P, Goss J, Busuttil R. Liver transplantation for adult polycystic liver disease. Hepatology 1998;28:412–415.

    Article  PubMed  CAS  Google Scholar 

  7. Torres V, Rastogi S, King B, Stanson AW, Gross JB, Nagorney DM. Hepatic venous outflow obstruction in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1994;5:1186–1912.

    PubMed  CAS  Google Scholar 

  8. Uddin W, Ramage JK, Portmann B, Wilson P, Benjamin I, Tan KC, Williams R. Hepatic venous outflow obstruction in patients with polycystic liver disease: pathogenesis and treatment. Gut 1995;36:142–145.

    PubMed  CAS  Google Scholar 

  9. Chauveau D, Pirson Y, Le Moine A, Franco D, Belghiti J, Grunfeld JP. Extrarenal manifestations in autosomal dominant polycystic kidney disease. Adv Nephrol Necker Hosp 1997;26:265–289.

    PubMed  CAS  Google Scholar 

  10. Yamagami T, Nakamura T, Kato T, Lida S, Nishimura T. Hemodynamic changes after self-expandable metallic stent therapy for vena cava syndrome. AJR Am J Roentgenol 2002;178:635–639.

    PubMed  Google Scholar 

  11. Saini S, Mueller PR, Ferruci JT, Simeone JF, Wittenberg J, Butch RJ. Percutaneous aspiration of hepatic cysts does not provide definite therapy. AJR Am J Roentgenol 1983;141:559–560.

    PubMed  CAS  Google Scholar 

  12. Trinki W, Sassaris M, Hunter FM. Nonsurgical treatment for symptomatic non-parasitic liver cysts. Am J Gastroenterol 1985;80:907–911.

    Google Scholar 

  13. Kairoluoma MI, Leinoneu A, Stahberg M, Paivansalo M, Kiviniemi H, Siniluoto T. Percutaneous aspiration and alcohol sclerotherapy for symptomatic hepatic cysts. Ann Surg 1989;210:208–215.

    Article  Google Scholar 

  14. Tokunaga K, Teplick SK, Banerjee B. Simple hepatic cysts: First case report of percutaneous drainage and sclerosis with doxycycline, with a review of literature. Dig Dis Sci 1994;39:209–214.

    Article  PubMed  CAS  Google Scholar 

  15. Van Sonnenberg E, Wroblicka JT, D’Agostino HB, Mathieson JRM, Casola G, O’Laoide R, Copperberg PL. Symptomatic hepatic cysts: Percutaneous drainage and sclerosis. Radiology 1994;190:387–392.

    Google Scholar 

  16. Ubara Y. New therapeutic option for autosomal dominant polycystic kidney disease patients with enlarged kidney and liver. Ther Apher Dial 2006;10:333–341.

    Article  PubMed  Google Scholar 

  17. Lin TY, Chen CC, Wang SM. Treatment of non-parasitic cystic disease of the liver: A new approach to therapy with polycystic liver. Ann Surg 1968;168:921–927.

    Article  PubMed  CAS  Google Scholar 

  18. Armitage NC, Blumgart LH. Partial resection and fenestration in the treatment of polycystic liver disease. Br J Surg 1984;71:242–244.

    Article  PubMed  CAS  Google Scholar 

  19. Vauthey J-N, Maddern G-J, Kolbinger P, Baer HU, Blumgart LH. Clinical experience with adult polycystic liver disease. Br J Surg 1992;79:562–565.

    Article  PubMed  CAS  Google Scholar 

  20. Henne-Bruns D, Klomp HJ, Kremer B. Non-parasitic liver cysts and polycystic liver disease: Results of surgical treatment. Hepatogastroenterology 1993;40:1–5.

    PubMed  CAS  Google Scholar 

  21. Farges O, Bismuth H. Fenestration in the management of polycystic liver disease. World J Surg 1995;19:25–30.

    Article  PubMed  CAS  Google Scholar 

  22. Que F, Nagorney DM, Gross JB, Torres VE. Liver resection and cyst fenestration in the treatment of severe polycystic liver disease. Gastroenterology 1995;108:487–494.

    Article  PubMed  CAS  Google Scholar 

  23. Soravia C, Mentha G, Giostra E, Morel P, Rohner A. Surgery for adult polycystic liver disease. Surgery 1995;117:272–275.

    Article  PubMed  CAS  Google Scholar 

  24. Gigot J-F, Jadoul P, Que F, Van Beers BE, Etienne J, Horsmans Y, Collard A, Guebel A, Pringot J, Kestens P-J. Adult polycystic liver disease: Is fenestration the most adequate operation for long-term management? Ann Surg 1997;225:286–294.

    Article  PubMed  CAS  Google Scholar 

  25. Koperna T, Vogl S, Satzinger U, Schulz F. Nonparasitic cysts of the liver: Results and options of surgical treatment. World J Surg 1997;21:850–854.

    Article  PubMed  CAS  Google Scholar 

  26. Starzl TE, Reyes J, Tzakis A, Mieles L, Todo S, Gordon R. Liver transplantation for polycystic liver disease. Arch Surg 1990;125:575–577.

    PubMed  CAS  Google Scholar 

  27. Washburn WK, Johnson LB, Lewis D, Jenkins RL. Liver transplantation for adult polycystic liver disease. Liver Transpl Surg 1996;2:17–22.

    Article  PubMed  CAS  Google Scholar 

  28. Lang H, Woellwarth J, Oldhafer KJ, Behrend M, Schlitt HJ, Nashan B, Pichlmayr R. Liver transplantation in patients with polycystic liver disease. Transplant Proc 1997;29:2832–2833.

    Article  PubMed  CAS  Google Scholar 

  29. Jeyarajah DR, Gonwa TA, Testa G, Abbasoglu O, Goldstein R, Husberg BS, Levy MF, Klintmalm GB. Liver and kidney transplantation for polycystic disease. Transplantation 1998;66:529–532.

    Article  PubMed  CAS  Google Scholar 

  30. Swenson K, Seu P, Kinkhabwala M, Maggard M, Martin P, Goss J, Busuttil R. Liver transplantation for adult polycystic liver disease. Hepatology 1998;28:412–415.

    Article  PubMed  CAS  Google Scholar 

  31. Kirchner GI, Rifai K, Cantz T, Nashan B, Terkamp C, Becker T, Strassburg C, Barg-Hock H, Wagner S, Lück R, Klempnauer J, Manns MP. Outcome and quality of life in patients with polycystic liver disease after liver or combined liver–kidney transplantation. Liver Transpl 2006;12:1268–1277.

    Article  PubMed  Google Scholar 

  32. Clive DM, Davidoff A, Schweizer RT. Budd–Chiari syndrome in autosomal dominant polycystic kidney disease: A complication of nephrectomy in patients with liver cysts. Am J Kidney Dis 1993;21:202–205.

    PubMed  CAS  Google Scholar 

  33. Torres VE, Rastogi S, King BF, Stanson AW, Gross JB, Nagorney DM. Hepatic venous outflow obstruction in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1994;5:1186–1192.

    PubMed  CAS  Google Scholar 

  34. Uddin W, Ramage JK, Portmann B, Williams R, Wilson P, Benjamin I, Tan K-C. Hepatic venous outflow obstruction in patients with polycystic liver disease: Pathogenesis and treatment. Gut 1995;36:142–145.

    PubMed  CAS  Google Scholar 

  35. Lopez RR, Benner KG, Hall L, Rosch J, Pinson CW. Expandable venous stents for treatment of the Budd–Chiari syndrome. Gastroenterology 1991;100:1435–1441.

    PubMed  Google Scholar 

  36. Griffeth JF, Mahmoud AEA, Cooper S, Elias E, West RJ, Olliff SP. Radiological intervention in Budd–Chiari syndrome: techniques and outcome in 18 patients. Clin Radiol 1996;51:775–784.

    Article  Google Scholar 

  37. Fletcher WS, Lakin PC, Pommier RF, Wilmarth T. Results of treatment of inferior vena cava syndrome with expandable metallic stents. Arch Surg 1998;133:935–938.

    Article  PubMed  CAS  Google Scholar 

  38. Zhang C-Q, Fu L-N, Xu L, Zhang G-Q, Jia T, Liu J-Y, Qin C-Y, Zhu J-R. Long-term effect of stent placement in 115 patients with Budd–Chiari syndrome. World J Gastroenterol 2003;9:2587–2591.

    PubMed  CAS  Google Scholar 

  39. Althaus SJ, Perkins JD, Soltes G, Glickerman D. Use of a wallstent in successful treatment of IVC obstruction following liver transplantation. Transplantation 1996;61:669–672.

    Article  PubMed  CAS  Google Scholar 

  40. Weeks SM, Gerber DA, Jaques PF, Sandhu J, Johnson MW, Fair JH, Mauro MA. Primary Gianturco stent placement for inferior vena cava abnormalities following liver transplantation. J Vasc Interv Radiol 2000;11:177–187.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We would like to thank Stephen Cha for assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA

    Jayleen Grams & David M. Nagorney

  2. Department of Surgery, Oregon Health Sciences University, Portland, OR, USA

    Swee H. Teh

  3. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    Vicente E. Torres

  4. Department of Vascular and Interventional Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA

    James C. Andrews

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  1. Jayleen Grams
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  2. Swee H. Teh
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  3. Vicente E. Torres
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  5. David M. Nagorney
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Correspondence to David M. Nagorney.

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Grams, J., Teh, S.H., Torres, V.E. et al. Inferior Vena Cava Stenting: A Safe and Effective Treatment for Intractable Ascites in Patients with Polycystic Liver Disease. J Gastrointest Surg 11, 985–990 (2007). https://doi.org/10.1007/s11605-007-0182-3

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  • DOI: https://doi.org/10.1007/s11605-007-0182-3

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