BENIGN OBSTRUCTION OF THE HEPATIC INFERIOR VENA-CAVA COMPLICATED BY HEPATOCELLULAR-CARCINOMA - COMBINED INTERVENTIONAL MANAGEMENT

OBJECTIVE. The risk of hepatocellular carcinoma is increased with beni gn obstruction of the hepatic inferior vena cava (TVC). The purpose of this study was to assess the usefulness of combined interventional tr eatment for benign obstruction of the hepatic TVC associated with hepa tocellular carcinoma. MATERIALS AND METHODS. In a retrospective review of 51 patients with benign obstruction of the hepatic IVC, hepatocell ular carcinoma was detected in 15 patients coincidentally or during th e follow-up period. Obstruction of the IVC was treated with percutaneo us transluminal balloon angioplasty in five patients and metallic sten t placement in two patients. Immediate postprocedural and follow-up ve nacavography was performed to evaluate the effectiveness of this inter ventional management. Hepatocellular carcinomas were managed with tran scatheter chemoembolization in all 15 patients using an emulsion of 3- 12 mi of an iodized oil and 20-50 mg of doxorubicin hydrochloride. Gel foam embolization was performed in three patients. Transcatheter chemo embolizations were repeated in seven patients. Initial response and lo ng-term response to treatment were evaluated by monitoring the level o f serum a-fetoprotein and by follow-up CT and angiography. RESULTS. Du ring the follow-up period (1-8 years), the NC was widely open except i n one patient who developed moderate stenosis. Clinical symptoms of ve na caval obstruction disappeared in all patients. After initial transc atheter chemoembolization, complete remission of the tumor occurred in six patients and partial remission occurred in seven patients. Five o f the seven patients who underwent further chemoembolizations remained unchanged or in remission. CONCLUSION. Radiologic interventional trea tment plays a significant role in managing both kinds of lesions in pa tients with benign obstruction of the hepatic IVC complicated by hepat ocellular carcinoma. A follow-up regimen should be designed to detect small hepatocellular carcinoma as early as possible after obstruction of the hepatic IVC is diagnosed.