Inferior Vena Cava Stenting: A Safe and Effective Treatment for Intractable Ascites in Patients with Polycystic Liver Disease

Abstract

We performed a retrospective study of seven patients with polycystic liver disease who underwent stenting of the inferior vena cava for intractable ascites. All patients had symptomatic ascites and inferior vena cava stenosis demonstrable by venography. The mean pressure gradient across the inferior vena cava stenosis before stenting was 14.5 mm Hg (range 6-25 mm Hg) and significantly decreased to a mean pressure gradient of 2.8 mm Hg (range 0-6 mm Hg, p = 0.008) after stenting. Two patients also had stenting of hepatic venous stenoses after unsuccessful inferior vena cava stenting. After a mean follow-up of 12.2 months (range 0.5-39.1 months), five of the seven patients have had maintained clinical improvement, defined as decreased symptoms, diuretic requirements, and frequency of paracentesis. Four patients have required no further intervention. The other patient was lost in follow-up. Patients with clinical improvement had an overall larger mean pressure gradient before stenting (19.2 vs. 9.8 mm Hg) and a larger Delta pressure gradient (15.8 vs. 7.8 mm Hg) compared to those in whom stenting was unsuccessful. These results suggest inferior vena cava stenting is safe and effective and should be considered as a first-line intervention in the treatment of medically intractable ascites in select patients with polycystic liver disease.

Polycystic liver disease: an overview of pathogenesis, clinical manifestations and management

“…Mechanical pressure symptoms of hepatomegaly may extend from hepatic veins to junctions with the vena cava inferior (IVC). Compression of IVC is characterized by increased renal outflow pressure that provokes development of ascites and edema in the lower extremities [36]. …”

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“…7 Placement of a self-expandable metallic stent in the IVC also has been reported to be useful, although not greatly, for PCLD. 2 Through compression of the IVC, hepatomegaly leads to an increase in venous pressure and causes ascites or lower-extremity edema. In the present case, placement of an IVC stent Although both TAE and IVC stenting are useful treatments to alleviate and treat PCLD, there has not been a report of these treatments being used in the same patient.…”

“…5,8 Placement of an indwelling IVC stent also does not typically result in severe complications. 2 Therefore, we implemented both treatments simultaneously and achieved rapid relief of symptoms without any apparent complications.…”

“…Depending on the patient, hepatomegaly may compress the inferior vena cava (IVC) of the liver, resulting in lower-extremity edema or ascites, the so-called inferior vena cava syndrome. 2 Similarly, compression of the portal vein owing to hepatomegaly also is known to cause portal hypertension, resulting in varices. 3 In such cases, surgical resection or interventional procedure (eg, transcatheter arterial embolization [TAE]) can be implemented to alleviate symptoms.…”

“…4,5 A self-expandable metallic stent also has been used (although not greatly) for inferior vena cava syndrome. 2 However, to the extent that we searched, we found no reports where TAE and IVC stenting had been implemented simultaneously in the same patient. We report a patient with polycystic liver disease (PCLD), complicated by autosomaldominant polycystic kidney disease, with a chief complaint of a full-stomach sensation and refractory ascites, wherein both TAE and IVC stenting had been implemented simultaneously, and the symptoms had been alleviated.…”