HEPATIC VENOUS OUTFLOW BLOCK CAUSED BY SHORT-LENGTH HEPATIC VEIN STENOSES

In contrast with the well-recognized membranous obstruction of the inf erior vena cava, short-length hepatic vein stenoses are not well recog nized causes of hepatic venous outflow block. The aim of this study wa s to ascertain the prevalence, causes, manifestations, and outcome of short-length hepatic vein stenoses. We performed a retrospective study of patients with short-length hepatic vein stenosis among 86 patients with hepatic venous outflow block who were seen between 1970 and 1992 . There were 25 patients with short-length hepatic vein stenosis. A th rombogenic condition was identified in 14 patients (56%). The lesions of the accompanying hepatic veins in these patients were variable (sho rt-length stenoses, thromboses, or nonspecific changes) and similar to that seen in patients without short-length hepatic vein stenosis. In 3 necropsied cases, the venous lesions were suggestive of fibrous sequ ela of prior thromboses. In patients with short-length hepatic vein st enosis, splenomegaly (28% vs. 55%, P < .05) and hypersplenism were sig nificantly less common; serum transaminase (P < .001) and creatinine l evels (P < .02) were lower, prothrombin was higher (P < .001), and 5-y ear survival was significantly better (Kaplan-Meier estimates: 80% vs. 50%, P < .05). In patients with hepatic venous outflow block, short-l ength hepatic vein stenosis is a common lesion that appears to be the sequela of localized thrombosis. Long-term anticoagulation and percuta neous angioplasty (with or without stenting) are potentially applicabl e in these lesions. The long-term results of these treatments merit fu rther evaluation.