Single-session total endovascular iliocaval reconstruction with stent grafting for the treatment of inferior vena cava agenesis and concurrent iliac venous.

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Inferior Vena Cava Agenesis and Total Caval Reconstruction

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Single-session total endovascular iliocaval reconstruction with stent grafting for the treatment of inferior vena cava agenesis and concurrent iliac venous aneurysm rupture Jeffrey Forris Beecham Chick, MD, MPH, DABR, Minhaj S. Khaja, MD, MBA, Steven Han, MD, Kyle J. Cooper, MD, J. Matthew Meadows, MD, David M. Williams, MD, FSIR Journal of Vascular Surgery Cases and Innovative Techniques Volume 3, Issue 3, Pages 132-135 (September 2017) DOI: 10.1016/j.jvscit.2017.02.012 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 A, Axial computed tomography (CT) image with intravenous administration of contrast material demonstrating the ruptured right common iliac vein aneurysm (white arrow) with surrounding retroperitoneal hematoma (arrowheads), as well as a left common iliac vein aneurysm (black arrow). B, Coronal CT image showing the ruptured right iliac vein aneurysm (arrow) with adjacent retroperitoneal hematoma (arrowheads). C, Dilated retroperitoneal collateral veins (arrowheads) with a diminutive inferior vena cava (IVC; white arrow). D, Dilated azygos (arrow) and hemiazygos (arrowhead) veins with absence of the IVC consistent with IVC agenesis. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 132-135DOI: (10.1016/j.jvscit.2017.02.012) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 A, Right femoral iliac arteriography showing no extravasation, arteriovenous fistula, or pseudoaneurysm of the external (arrow) or internal (arrowhead) iliac arteries. B, Right ascending saphenous venography demonstrating a 5.5-cm ruptured common and external iliac vein aneurysm (arrowheads). There are filling defects within the right common femoral vein consistent with thrombus (arrow). C, A left common iliac vein aneurysm is appreciated as well (arrowhead). D, Serial balloon angioplasty of the inferior vena cava (IVC, arrow) and iliac veins. E, Placement of 20- × 55-mm Wallstent endoprostheses in the suprarenal and infrarenal IVC, a 20- × 50-mm Gianturco Z-stent at the renal confluence (arrow), and 14- × 90-mm Wallstent endoprostheses in the IVC into the proximal common iliac veins. F, Ruptured right iliac vein aneurysm excluded with overlapping 16- × 156-mm and 16- × 93-mm Medtronic Endurant II stent grafts (arrowheads). G and H, Completion venography showing restoration of in-line flow from the right common femoral vein to the suprarenal IVC with exclusion of right iliac vein aneurysm (arrowheads). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 132-135DOI: (10.1016/j.jvscit.2017.02.012) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 A and B, Completion venography demonstrating brisk in-line flow from both femoral veins to the suprarenal inferior vena cava (IVC) without stenosis, thrombus, or aneurysm. Both the ruptured right iliac vein aneurysm (B; arrowheads) and left iliac vein aneurysm have been excluded. The Gianturco Z-stent is seen at the renal confluence (A; arrowheads). C, Coronal reformatted computed tomography (CT) image demonstrating the widely patent iliocaval reconstruction. D, Coronal reformatted CT image showing the patent iliac vein stent graft (white arrowheads) with adjacent retroperitoneal hematoma (arrow). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 132-135DOI: (10.1016/j.jvscit.2017.02.012) Copyright © 2017 The Author(s) Terms and Conditions