This protocol addresses inferior vena cava syndrome occurring in the context of Budd-Chiari syndrome (BCS) — a rare occlusive condition affecting the hepatic veins and/or the inferior vena cava — where obstruction and/or thrombosis of the IVC or hepatic veins is present.
Inferior vena cava syndrome may develop as a manifestation of Budd-Chiari syndrome, in which the IVC and/or hepatic veins become occluded. Interventional recanalization is applicable specifically in cases involving obstruction or thrombosis of the IVC and the larger hepatic veins; diffuse forms are managed differently.
The strategy for this presentation centres on endovascular recanalization to restore vessel patency. Depending on lesion characteristics, this may involve a combination of catheter-based interventional techniques. Anticoagulation plays a role both before and after the procedure in selected patients.
IVCS may also develop in Budd-Chiari syndrome (BCS), a rare occlusive disease affecting the hepatic veins (HV) and/or the IVC.
Recanalization procedures in BCS are restricted to cases with obstruction and/or thrombosis of the IVC and the larger hepatic veins, while in diffuse HV-obstruction and in veno-occlusive type interventional recanalization is impossible.
Alternatively, primary interventional strategies with thrombus aspiration, thrombus retrieval, and/or catheter-directed thrombolysis followed by stent placement have been advocated.
BCS-Patients with thrombotic lesions are either managed conservatively with long-term anticoagulation or receive pre-interventional treatment with anticoagulant drugs to reduce clot burden.
Long-term anticoagulation after interventional therapy of BCS is recommended to avoid re-thrombosis and stent occlusion.
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