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Hepatic venous outflow block caused by short‐length hepatic vein stenoses
Author(s) -
Valla D,
Hadengue A,
el Younsi M,
Azar N,
Zeitoun G,
Boudet M,
Molas G,
Belghiti J,
Erlinger S,
Hay J,
Benhamou J
Publication year - 1997
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510250405
Subject(s) - medicine , stenosis , sequela , vein , inferior vena cava , percutaneous , thrombosis , radiology , surgery , cardiology
In contrast with the well‐recognized membranous obstruction of the inferior vena cava, short‐length hepatic vein stenoses are not well‐ recognized causes of hepatic venous outflow block. The aim of this study was to ascertain the prevalence, causes, manifestations, and outcome of short‐length hepatic vein stenoses. We performed a retrospective study of patients with short‐length hepatic vein stenosis among 86 patients with hepatic venous outflow block who were seen between 1970 and 1992. There were 25 patients with short‐length hepatic vein stenosis. A thrombogenic condition was identified in 14 patients (56%). The lesions of the accompanying hepatic veins in these patients were variable (short‐length stenoses, thromboses, or nonspecific changes) and similar to that seen in patients without short‐length hepatic vein stenosis. In 3 necropsied cases, the venous lesions were suggestive of fibrous sequela of prior thromboses. In patients with short‐length hepatic vein stenosis, splenomegaly (28% vs. 55%, P < .05) and hypersplenism were significantly less common; serum transaminase ( P < .001) and creatinine levels ( P < .02) were lower, prothrombin was higher ( P < .001), and 5‐year survival was significantly better (Kaplan‐Meier estimates: 80% vs. 50%, P < .05). In patients with hepatic venous outflow block, short‐length hepatic vein stenosis is a common lesion that appears to be the sequela of localized thrombosis. Long‐term anticoagulation and percutaneous angioplasty (with or without stenting) are potentially applicable in these lesions. The long‐term results of these treatments merit further evaluation.