Total Iliocaval Chronic Occlusion Recanalization and Double Barrel Stenting Across Bilateral Renal Veins

Chronic iliocaval long segment occlusions significantly impact quality of life and present several challenges. These challenges include the fact that intimal hyperplasia is more pronounced in venous system no current covered stents are approved for treatment chronic occlusions, as well difficulty establishing adequate inflow outflow. Since low flow, it naturally predisposed towards thrombogenicity, which an additional hurdle this clinical entity. When important vessels involved, decision to jail these can also be controversial. Despite this, endovascular management with angioplasty stenting provides good long-term patency improves symptoms majority patients currently technique choice1Hartung O. Loundou A.D. Barthelemy P. Arnoux D. Boufi M. Alimi Y.S. Endovascular disabling ilio-caval obstructive lesions: results.Eur J Vasc Endovasc Surg. 2009; 38: 118-124Abstract Full Text PDF PubMed Scopus (158) Google Scholar. Surgery should considered only if fails. We a case inferior vena cava (IVC) occlusion involvement from suprahepatic, intrathoracic external iliac veins bilaterally. The patient consented publication case. This 40-year-old female history multiple recurrent bilateral lower extremity deep thromboses antiphospholipid syndrome on lifelong anticoagulation warfarin. They presented complaint swelling burning pain, recalcitrant, nonhealing, left stasis ulcer had previously failed compression treatments over time. Their initial Villalta score was 21 Venous Clinical Severity Score (VCSS) 19. Workup computed tomography venography (CTV) showed diminutive occluded IVC extending suprahepatic cava, down veins, well-developed collaterals. Hyperdense material noted within lumen, cranially hepatic confluence, contrast opacification evident throughout most its trajectory. Occlusion determined due intraluminal hyperdense seen CTV, corroborated by intraoperative findings need advanced recanalization techniques. femoropopliteal were patent bilaterally, nonocclusive thrombosis distal third common femoral vein middle popliteal vein, spontaneous phasic flow spectral Doppler. Thus, made perform reconstruction. Baseline creatinine 0.72 mg/dL. procedure performed using groins right internal jugular (IJV) access. Selective renal confirm collateralization necessity crossing both open-celled stents. recanalized via IJV access described our group2Rodriguez L.E. Tabrizi R. Malgor R.D. Wohlauer Jacobs D.L. Sharp Recanalization Upstream GoBack Catheter Occlusive Ilio-Caval Thrombosis.Ann 2021; 74: 518 e7-e11Abstract (0) Scholar Reentry V18 heavy-tipped guidewire specific total occlusions. Intravascular ultrasound (IVUS) evaluation disease extent, stent sizing3Raju S. Buck W.J. Crim W. Jayaraj A. Optimal sizing stents.Phlebology. 2018; 33: 451-457Crossref (75) confirmation expansion. double barrel into minimized performing surface area calculation provide comparable flow4Jayaraj Thaggard Lucas Technique symptomatic iliofemoral obstruction - IVUS channel luminal area-based associated term outcomes.J Surg Lymphat Disord. 2023; Abstract discharged postoperative day 1, serum 0.67 mg/dL, sent home low-molecular weight heparin (LMWH) aspirin 81mg daily. transitioned back warfarin after 4 weeks, INR 3.5 will maintained life-long 1 month follow-up 0.76 3-dimensional multiplanar reconstruction 3-month CT shows full extent stenting, border T10 vertebra Figure 1. same stents, decreased abdominal wall edema, collateral size. Also, reported complete resolution pain swelling, healed, 9 initially, VCSS 6 19 initially. Follow-up imaging planned at months, year, annually thereafter. It explained nature disease, procedures would likely necessary maintain system’s tendency produce sustained hyperplasia, risk erosion adjacent structures, while rare, exists. illustrates fundamental role plays various aspects complex disease5Gagne P.J. Tahara R.W. Fastabend C.P. Dzieciuchowicz L. Marston Vedantham et al.Venography versus intravascular diagnosing treating obstruction.J 2017; 5: 678-687Abstract (127) Scholar, underscores importance obtaining Renal jailing ensure outflow may appropriate cases where functionally deemed adequate. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1ZjlkOGQxMDUyZDMwZmI2OGUwZGNiN2Y0ZmI2YTU2MyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg4MjkwNTA4fQ.jByUA4qeIkuNrx8ECkOgV6W4nybAOajqThoUj2cA4UU2zfbVoMT7nm73Vp7zlLhR7ozeempTaTkEJ5kpVdvWKZyI-qmzbKKrJmFvxqVZEWusQTrqnZVpUygM96jhKoHmGQbNd7wT1sj7I0lMXwb0KwC2UksEsLWJZydeQ63f3yDg3yfItGYUqatMNSCJVKAEueP0Uh1fVlbx1vpG5tW7rLKE-QuMmH0_5jFEgPbBIUWEXvnRvjUsqbTVVY5RgWPC5SUehaxu-VrJmi8BBEs7tM2v8N3WOegAfY1LFTjyoWdO82SPmXrK31P4Y3oAD7b8fCqnG6oSV7YH4FfzcWndLA Download .mp4 (124.15 MB) Help files