Combination of Thrombolytic Therapy and Angioplastic Stent Insertion in a Patient with Budd-Chiari Syndrome Report of a Case

Abstract: A 31-year-old female with well-established polycythemia vera since one year before,presentedwiththesuddenonsetoftenseascitesandhepaticencephalopathysince 12 days prior to admission. Real-time ultrasonography revealed a suprahepatic thrombosis extendingtowardtheinferiorvenacava(IVC).Thrombolytictherapywithsystemicstreptokinase (250,000 IU loading + 100,000 IU/hr infusion)was started. At theend of 72hours' infusion, the patient’s general condition improved. A color Doppler ultrasonography, then showedcompleteandpartialresolutionofthethrombosisinthesuprahepaticveinandIVC, respectively.Despitethisgoodresponse,12dayslater,thesymptomsrecurred.Venography detected complete obstruction of the IVC. Percutanous balloon angioplasty with stent insertionwasperformedsuccessfullyandthepatientwasdischargedwithoutanyevidence of liverdisease.A combinationofsystemicstreptokinaseandradiological interventionwas effectiveinourpatient.