Recanalization of occluded IVC filter and iliocaval obstruction, postphlebitic
Affiliations: Vascular Surgery, Consultant and Lecturer of Vascular Surgery, Ain Shams University, Cairo, Egypt
Endovascular intervention is now considered the first-line therapy for stenotic or occluded iliofemoral veins with low morbidity and high clinical success.
A case report / challenging case:
Case details: A 46-year-old male patient with a history of recurrent deep venous thrombosis (DVT) and inferior vena cava (IVC) filter insertion 8 years prior presented with significant lower-limb edema in the thigh and leg, pronounced venous claudication, and severe lower-limb heaviness and pain that restricts his daily activities.
Technique: Ultrasound-guided venous access was conducted on the common femoral veins bilaterally under general anesthesia. A 0.018 guidewire (GW) was utilized to traverse the lesion, facilitated by crossing within the IVC filter at the same anatomical point on both sides. This was accomplished using a 0.018 GW, followed by an exchange to a 0.035 hydrophilic GW over a supporting catheter.
Predilation was performed using a 5 mm × 80 mm balloon within the IVC filter, subsequently followed by the dilation of a venous-specific balloon measuring 14 mm × 100 mm (Atlas Gold, Bard) to pressures ranging from 16 to 18 atm concurrently. The IVC filters were laterally displaced. The dilatation of the obstructed iliocaval segment was carried out using the same 14 mm balloon. Following this, venoplasty and stenting were executed with a total of 4 stents: 2 stents measuring 14 mm × 140 mm (Vonovo, Bard) and 2 additional stents measuring 14 mm × 90 mm, composed of braided stainless steel (Wallstents; Boston Scientific, Natick, Massachusetts, USA). All diseased segments, as identified by intravascular ultrasound (IVUS), were comprehensively covered by the stent to ensure adequate inflow and outflow.
Figure 1. Before and after recanalization of occluded inferior
vena cava filter.
Patent IVC, improvement of symptoms, and no complications.
Endovascular recanalization of occluded IVC and filter is possible with marked improvement in pain and quality of life and low risk of mortality. A composite dedicated venous stent and eligiloy Wallstent is feasible with overlapping 2-3 mm.
