Background: Hepatic venous outflow obstruction (HVOO) can have acute or chronic presentation.In the chronic variety of inferior vena cava (IVC) obstruction, endovascular management with balloon angioplasty and stent implantation has emerged as a feasible, safe alternative to surgery which has high incidence of mortality and morbidity.
Aims and objectives:To study the feasibility and long-term follow-up of endovascular management of chronic IVC obstruction.
Methods:We studied 12 cases of HVOO who underwent endovascular management (balloon dilatation ± stenting). In most of the cases, the cause of obstruction was not obvious, but one case had metastatic hepatic nodules compressing on IVC. Diagnosis was established by clinical examination, venous Doppler and was confirmed by venography and/or computed tomography (CT) angiography. Cases underwent balloon dilatation and/or stenting.Results: Out of 12 cases, six had membranous obstruction (four complete and two incomplete), five cases had segmental stenosis and one case had tumour compression. The lesion was crossed with either guide wire or Brockenbrough needle with Mullins sheath assembly and balloon dilatation was done with Inoue or Mansfield balloon. Seven cases underwent balloon dilatation alone while five cases underwent stenting. There was procedural success in all cases with reduction of gradient by 84%, disappearance of collaterals and clinical improvement. During the follow-up of 13 years, one case had restenosis, which was managed by stenting.Conclusion: Endovascular management of IVC obstruction is safe with good long-term patency rates.
OCD could be a long-term sequel in adults with a history of rheumatic fever in childhood, even in the absence of frank chorea. The findings call for systematic research in this little explored area.
Aortic root abscess is one of the dreaded complications of aortic valve infective endocarditis. It carries a very high morbidity and mortality. Early diagnosis and surgical treatment is the main key. Echocardiography aids in early detection of this complication. We report a 22 year old male patient of bicuspid aortic valve with native aortic valve endocarditis complicated with formation of aortic root abscess and severe aortic regurgitation(AR) through an Left ventricular outflow tract(LVOT) tunnel.
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