Nonoperative treatment of membranous obstruction of the inferior vena cava by percutaneous balloon transluminal angioplasty

Percutaneous transluminal angioplasty (PTA) was performed with the Inoue balloon catheter in nine patients with membranous obstruction of the inferior vena cava (MOVC) between November 1988 and April 1991. There were five men and four women, aged 30.8 +/- 8.5 years. Two patients had had previous surgical treatment. Three patients had complete and six had incomplete MOVC. The caval pressure below the MOVC was 24.0 +/- 5.6 and 11.8 +/- 5.3 mm Hg (p less than 0.0001) before and after PTA, respectively. The caval diameter at the site of MOVC increased from 1.5 +/- 1.7 to 20.3 +/- 2.6 mm (p less than 0.0001), and the maximal caval diameter below the MOVC decreased from 28.7 +/- 12.9 to 19.8 +/- 9.9 mm (p = 0.006), before and after PTA, respectively. One patient died of massive pulmonary embolism following successful PTA. All the other eight patients remained asymptomatic during an 18.5 +/- 11.5 months (range 3.5 to 32) follow-up period. Two-dimensional ultrasonograms showed no recurrence of MOVC. We conclude that PTA with the Inoue balloon catheter is an effective and safe alternative to surgical treatment of MOVC.