Budd-Chiari syndrome with fresh inferior vena cava thrombosis: agitation thrombolysis and balloon dilation

Background: To evaluate retrospectively our initial clinical experience of agitation thrombolysis and balloon dilation in the treatment of Budd-Chiari syndrome (BCS) in patients with fresh inferior vena cava (IVC) thrombosis. Patients and methods: Between August 2004 and March 2009, a total of 12 BCS patients with fresh IVC thrombosis were treated with agitation thrombolysis and balloon dilation. Color Doppler ultrasound results, as well as mortality, morbidity, and the clinical outcomes were evaluated immediately after the treatment and at one week and 1, 3, 6, 12 months after the procedure and then annually thereafter. Results: Agitation thrombolysis and balloon dilation were technically successful in all patients, without immediate procedural complications. The inferior vena cavagrams after the procedure demonstrated complete resolution of the IVC thrombi without pulmonary embolism and full patency of the obstructed IVC. Thirty-day mortality was nil. Clinical success was observed in all patients respectively one month after the procedure. As of February 2010, the mean (+/- SD) follow-up period for the color Doppler ultrasound procedure was 21.7 +/- 8.9 months (range, 12-32 months). All patients showed complete patency of the treated IVC without thrombosis, restenosis, or reobstruction, and all patients are alive with resolution of the symptoms at the time of this report. Conclusions: Our preliminary results suggest that agitation thrombolysis and balloon dilation may be a feasible approach for patients with BCS and fresh IVC thrombosis. However, larger studies are warranted to confirm these results.