Abstract
Five patients with inferior vena caval (IVC) obstruction in the hepatic portion were treated surgically in Kumamoto University Hospital during the past eight years. Two cases of membranous obstruction of IVC in the hepatic portion were successfully treated by percutaneus transluminal membranotomy using Brockenbrough's catheter. Two patients with non-membranous obstruction of the IVC in the hepatic portion received bypass operations between the IVC and the right atrium, by means of an expanded polytetrafluoroethylene (EPTFE) graft with external ring support. In the case of intracacitary cardiac extension of hepatocellular carcinoma, palliative removal of the tumor in the right atrium and the IVC was performed under cardiopulmonary bypass. In four cases, clinical improvement was achieved without any postoperative complications although, in a case of the non-membranous type of obstruction, the patient died of hepatic insufficiency three months after the operation. In a case of membranous obstruction of the IVC in the hepatic portion, transluminal membranotomy was less invasive, and effective. In some cases of IVC obstruction due to a malignant tumor, palliative resection of the tumor, although not curative, may be of value for clinical improvement with better quality of life.
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