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Treatment of Budd-Chiari syndrome with urokinase following predilation in patients with old inferior vena cava thrombosis

Trattamento della sindrome di Budd-Chiari mediante pre-dilatazione con urochinasi in pazienti con trombosi cronica della vena cava inferiore

  • Vascular and Interventional Radiology / Radiologia Vascolare Ed Interventistica
  • Published:
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Abstract

Purpose

This study was undertaken to evaluate the safety and feasibility of thrombolytic urokinase treatment after predilation in patients with Budd-Chiari syndrome (BCS) with chronic inferior vena cava (IVC) thrombosis.

Materials and methods

Between December 2006 and September 2009, 13 consecutive BCS patients with chronic IVC thrombosis were treated with continuous urokinase infusion after predilation and subsequent (i.e. after thrombus resolution) IVC dilation with a 30-mm dilator. The procedural technical and angiographic, and ultrasonic results, as well as mortality, morbidity and the final clinical outcome, were evaluated immediately after the treatment or at 1 week and 1, 3, 6 and 12 months and then annually thereafter.

Results

The immediate and long-term procedural technical outcome was successful in all patients. Follow-up inferior vena cavagrams demonstrated complete resolution of the chronic IVC thrombi and full IVC patency, without occurrence of pulmonary embolism at any time during the study. Colour-Doppler ultrasound (US) follow-up for 16.92 months (±12.04) showed full patency of the IVC, without thrombosis, restenosis or reobstruction, in all patients and resolution of all clinical symptoms. All patients were alive at the time of this report.

Conclusions

Our preliminary results indicate that thrombolysis with continuous infusion of urokinase after predilation is a safe and feasible approach for treating BCS patients with chronic IVC thrombosis.

Riassunto

Obiettivo

Questo studio è stato condotto per valutare la sicurezza e la fattibilità del trattamento trombolitico con urochinasi dopo pre-dilatazione in pazienti con sindrome di Budd-Chiari (BCS) con trombosi cronica della vena cava inferiore (IVC).

Materiali e metodi

Tra il dicembre 2006 e il settembre 2009, 13 pazienti BCS con trombosi cronica dell’IVC sono stati trattati con infusione urochinasica continua dopo predilatazione e successiva (i.e. in seguito alla risoluzione del trombo) dilatazione dell’ IVC con un dilatatore di 30 mm. Le procedure tecniche ed angiografiche, e i risultati ecografici, cosi come la mortalità, la morbidità, e i risultati clinici finali, sono stati valutati immediatamente dopo il trattamento, a una settimana e a 1, 3, 6, e 12 mesi e infine annualmente.

Risultati

I risultati immediati ed a lungo termine della tecnica procedurale hanno avuto successo in tutti pazienti. Le flebografie di follow-up della vena cava inferiore hanno dimostrato una completa risoluzione della trombosi cronica dell’ IVC e totale pervieta’ dell’ IVC, senza alcun caso di embolia polmonare durante lo studio. Il follow-up con ecografia Color-Doppler (US) a 16.92 mesi (±12.04) ha mostrato completa pervietà dell’ IVC, senza trombosi, restenosi o riostruzione, in tutti i pazienti e risoluzione di tutti i sintomi clinici. Ad oggi tutti i pazienti sono sopravvissuti.

Conclusioni

I nostri risultati preliminari indicano che la trombolisi con infusione continua di urochinasi dopo predilatazione è un approccio sicuro e fattibile per il trattamento dei pazienti BCS con trombosi cronica dell’ IVC.

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Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China

    P. -X. Ding, Y. -D. Li, X. -W. Han, G. Wu, S. -F. Shui & Y. -L. Wang

  2. No.1, East Jian She Road, Zhengzhou, 450052, Henan Province, China

    X. -W. Han

Authors
  1. P. -X. Ding
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  2. Y. -D. Li
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  3. X. -W. Han
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  4. G. Wu
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  5. S. -F. Shui
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  6. Y. -L. Wang
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Corresponding author

Correspondence to X. -W. Han.

Additional information

Note: P-X. Ding and Y-D. Li contributed equally to this study

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Ding, P.X., Li, Y.D., Han, X.W. et al. Treatment of Budd-Chiari syndrome with urokinase following predilation in patients with old inferior vena cava thrombosis. Radiol med 116, 56–60 (2011). https://doi.org/10.1007/s11547-010-0600-6

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  • DOI: https://doi.org/10.1007/s11547-010-0600-6

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