Results of treatment of inferior vena cava syndrome with expandable metallic stents

Background: Patients with hepatic metastases often develop obstruction of the intrahepatic inferior vena cava (IVC), known as IVC syndrome. This obstruction is debilitating due to the development of ascites and anasarca. Objectives: To update our experience in the diagnosis and treatment of IVC syndrome and to evaluate the efficacy of expandable stents in the treatment of IVC syndrome. Design: Retrospective review. Setting: University hospital. Patients: Twenty-eight patients with hepatic metastases diagnosed as having IVC syndrome. Intervention: Patients underwent transfemoral placement of Gianturco-Rosch self-expandable Z metallic stents in the intrahepatic IVC. One patient was treated with a Wallstent. Stents were 15 to 25 mm in diameter and 60 to 140 mm in length. Pressure gradients across the IVC were measured before and after stent placement in all patients. Main Outcome Measures: Change in pressure gradient, relief of ascites and anasarca, loss of weight, patency of the primary stent, and survival after stent placement. Results: Pressure gradients were reduced in all patients, which was followed by rapid reduction of ascites and anasarca with a median weight loss of 5.85 kg. Survival after stent placement varied from 1 to 99 days, with a mean of 34 days. Stent patency remained until death in all patients. Conclusion: The debilitation of IVC syndrome due to ascites and anasarca can be considerably palliated by placement of transfemoral percutaneous stents.