Outcomes of thrombolysis with and without predilation of the inferior vena cava (IVC) in patients with Budd-Chiari syndrome with old IVC thrombosis.

PURPOSE: To compare the efficacy of thrombolysis with and without predilation of the inferior vena cava (IVC) for Budd-Chiari syndrome (BCS) with old IVC thrombosis.

METHODS: We divided 40 patients with BCS with old IVC thrombosis into 2 groups, group A (n = 21), thrombolysis after dilation of the obstructed IVC and group B (n = 19), thrombolysis without predilation of the obstructed IVC. Thrombolysis was performed via urokinase administration through the dorsal vein of the foot.

RESULTS: Color Doppler ultrasonography at 30 days showed complete resolution of the thrombus in 21 (100%) group A patients and 6 group B patients (31.6%; P < .001). Thrombolysis was achieved using a lower dose of urokinase and within a shorter time frame in group A than in group B (P < .001).

CONCLUSIONS: Thrombolysis after dilation was superior to thrombolysis alone and was safe and efficacious in patients with BCS with old IVC thrombosis.