Recanalization of the intentionally interrupted inferior vena cava

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Recanalization of the intentionally interrupted inferior vena cava Arpit H. Gandhi, MD, Thomas W. Wakefield, MD, David M. Williams, MD Journal of Vascular Surgery Volume 62, Issue 3, Pages 747-749 (September 2015) DOI: 10.1016/j.jvs.2014.02.039 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 A, A baseline right iliocaval venogram in a woman with inferior vena cava (IVC) ligation reveals iliocaval occlusion and large, tortuous paraspinous collaterals (arrows). The right femoral sheath has been advanced through the occluded external iliac vein into the post-thrombotic common iliac vein. The left common iliac vein emptied through the left ascending lumbar system (not shown). B, Imaging during the recanalization procedure shows the angioplasty balloon inflated at the IVC ligation site. C, After recanalization and iliocaval stenting, bilateral iliocaval venograms demonstrate patent iliac veins and IVC. There is scant filling of the left ascending lumbar system, likely related to its very large size and dependent location, with passive filling of high-density contrast (arrow). Journal of Vascular Surgery 2015 62, 747-749DOI: (10.1016/j.jvs.2014.02.039) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Imaging during the recanalization procedure shows thrombosed iliocaval Wallstents (Boston Scientific, Natick, Mass) from a prior failed attempt. The inferior vena cava (IVC) stent (notched arrow) lies anterolateral to the Mobin-Uddin (M-U) filter (solid arrow), its rostral end pursed in retroperitoneal tissue. The back end of a stiff Glidewire (line arrow; Terumo Medical Corp Somerset NJ), loaded within an angioplasty balloon, has penetrated the roof of the left common iliac vein stent, the medial wall of the IVC stent, and the membrane of the M-U filter, and is poised to enter native, patent IVC and loop snare (open arrow). B, An iliocaval venogram, 44 months after the recanalization procedure, shows the iliocaval stents routed medial to the extracaval stent. A balloon-expanded stent buttresses the caval Wallstent. The iliocaval stents are widely patent, with mild filling of dependent retroperitoneal veins (line arrows). Intravascular ultrasound (US) examination of the IVC and iliac veins showed no significant in-stent stenosis or other obstructive lesion. Journal of Vascular Surgery 2015 62, 747-749DOI: (10.1016/j.jvs.2014.02.039) Copyright © 2015 Society for Vascular Surgery Terms and Conditions