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首页> 外文期刊>Ibnosina Journal of Medicine and Biomedical Sciences >Successful Local Thrombolytic Therapy in a Patient with Subacute Budd-Chiari Syndrome: Case Report and Review of Literature
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Successful Local Thrombolytic Therapy in a Patient with Subacute Budd-Chiari Syndrome: Case Report and Review of Literature

机译：亚急性布加综合征患者的成功局部溶栓治疗：病例报告和文献复习

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Background: Management of Budd-Chiari syndrome (BCS) includes different interventions and surgical procedures. There is limited data regarding catheter directed thrombolysis when treating this condition but it appears to be helpful in the case illustrated below.?Case report: A 29 year-old woman was referred to KFSH&RC with one month history of right upper abdominal pain, progressive abdominal distension and intermittent fever not associated with rigors. There was no history of oral contraceptive use. She had mild right upper quadrant tenderness and abdominal distention with moderate elevation of liver enzymes. Her serology was negative for viral hepatitis, autoimmune or cholestatic liver disease.Computed tomography (CT) angiogram of the abdomen showed a large amount of ascites with extensive thrombosis of the inferior vena cava (IVC) involving the hepatic and left renal veins. There was also complete occlusion of the left common iliac vein confirmed by venogram.An infusion catheter was placed through the thrombosed segment of the IVC and right hepatic artery. Thrombolytic therapy was started with the injection of 5 mg of recombinant tissue plasminogen activator (t-PA) as a loading dose followed by 0.3 mg per hour. Enoxaparin and oral warfarin were started simultaneously and once the target was reached, enoxaparin was stopped and warfarin was continued indefinitely. Ascites was well controlled with diuretics and large-volume paracentesis. A follow up venogram showed partial recanalization of?IVC and hepatic veins. A repeat CT scan after 14 weeks showed complete resolution of the thrombus. After 28 months, she is currently asymptomatic with normal liver function tests and total resolution of the ascites.Conclusion: The data on local thrombolysis is limited and the agents and doses are not uniform among reported cases but this case report shows that it can be considered in acute BCS with partial obstruction, followed by angioplasty or TIPS if unsuccessful.
机译：背景：Budd-Chiari综合征（BCS）的管理包括不同的干预措施和手术程序。治疗这种情况时，有关导管定向溶栓的数据有限，但在以下情况下似乎有所帮助。病例报告：一名29岁妇女因右上腹疼痛，进行性腹痛病史一个月转诊至KFSH＆RC膨胀和间歇性发烧与严峻性无关。没有口服避孕药史。她有轻度的右上腹压痛和腹胀，肝酶适度升高。她的病毒性肝炎，自身免疫性或胆汁淤积性肝病血清学阴性。腹部计算机断层扫描（CT）血管造影显示大量腹水，下腔静脉（IVC）广泛血栓形成，累及肝和左肾静脉。经静脉造影证实左common总静脉完全闭塞。将输液导管穿过IVC和右肝动脉的血栓段。溶栓治疗开始于注射5 mg重组组织纤溶酶原激活剂（t-PA）作为负荷剂量，然后每小时注入0.3 mg。同时开始使用依诺肝素和口服华法林，一旦达到目标，应停止依诺肝素，并无限期继续使用华法林。利尿剂和大量穿刺术可很好地控制腹水。静脉造影显示IVC和肝静脉部分再通。 14周后重复CT扫描显示血栓完全消失。 28个月后，她目前无症状，肝功能检查正常且腹水完全消退。结论：在报告的病例中局部溶栓的数据有限，药剂和剂量不统一，但本病例报告表明可以考虑急性BCS伴部分梗阻，如果不成功则进行血管成形术或TIPS。

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