013 - Complex venous reconstruction for chronic iliofemoral deep vein thrombosis: Pearls and Pitfalls
Sanghun Kim, MD – Resident Physician, University of Mississippi Medical Center; Jay Vasani, MD – Attending Physician, University of Mississippi Medical Center; Ajinkya Desai, MD – Attending Physician, University of Mississippi Medical Center
Purpose: Case-based review of recanalization techniques for chronic post-thrombotic iliofemoral venous occlusions, and to provide an overview of factors that cause stent failure.
Material and Methods: Five cases of patients with a history of DVT and symptoms of post-thrombotic syndrome (PTS), either with or without history of prior stenting, were selected. The first case demonstrates successful recanalization and stenting of a chronic left iliac vein occlusion. The second case demonstrates successful thrombolysis and stent relining in the left iliac vein after poor inflow related stent occlusion. The third case demonstrates successful thrombolysis and stent re-alignment in the left iliac vein after poor outflow related stent occlusion. The fourth case demonstrates successful recanalization of a right iliofemoral vein which had become occluded due to inappropriate placement of a left common iliac stent causing right common iliac vein outflow obstruction. The fifth case demonstrates successful iliocaval recanalization and stenting of an IVC filter related occlusion involving the infra-renal IVC and bilateral iliac veins; this case includes a complex, forceps-requiring, filter removal.
Results: In each of the provided cases, patients with PTS related symptoms including severe pain, swelling, and skin ulceration were found to have symptom improvement after recanalization and proper stenting. In some of these cases, prior stenting with poor technique resulted in re-occlusion and the need for re-intervention. Utilizing proper stenting technique reduces this risk of re-occlusion and therefore reduces the need for re-intervention.
Conclusions: Venous recanalization and stenting provides relief from the disabling symptoms of PTS and therefore improves the quality of life of patients. Appropriate stenting technique is essential for long-term stent patency and symptom relief.