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

• Published in: Radiologia medica Vol. 116; no. 1; pp. 56 - 60
• Main Authors: Ding, P. -X., Li, Y. -D., Han, X. -W., Wu, G., Shui, S. -F., Wang, Y. -L.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.02.2011
• Subjects: Adult; Aged; Angiography; Budd-Chiari Syndrome - diagnostic imaging; Budd-Chiari Syndrome - drug therapy; Budd-Chiari Syndrome - mortality; Catheterization; Contrast Media; Diagnostic Radiology; Feasibility Studies; Female; Fibrinolytic Agents - therapeutic use; Humans; Imaging; Interventional Radiology; Iohexol - analogs & derivatives; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Radiologia Vascolare Ed Interventistica; Radiology; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasound; Urokinase-Type Plasminogen Activator - therapeutic use; Vascular and Interventional Radiology; Vena Cava, Inferior; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - drug therapy; Venous Thrombosis - mortality; Sindrome di Budd-Chiari; Budd-Chiari syndrome; Vena cava inferiore; Thrombus; Trombolisi; Thrombolysis; Trombosi; Inferior vena cava
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-010-0600-6

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.