gms | German Medical Science

Background: Venous disease is common among the general population, with venous disorders affecting 50% to 85% of the Western population and consuming 2% to 3% of health care funding; therefore, it carries a significant socioeconomic, physical, and psychological burden. Patients with iliofemoral deep venous thrombosis are at risk for development of post-thrombotic syndrome. Ilio-caval segment vein stenting has been shown to significantly improve clinical outcomes in patients with venous outflow obstruction. Our case report shows results of iliocaval venous intervention in young patient with venous outflow obstruction due to post-thrombotic chronic venous occlusive disease

Methods: 37-year-old female was administrated in our institution, with acute pain in lower part of abdomen and pelvis. History of pain first appeared few years ago and more severe during menstruation, urination and coitus. Pain required the regular use of pain medications (Non Steroids). In infancy (1 month age), she has history of open venotomy of both femoral veins, Post-thrombotic syndrome was suspected and Duplex US, MRI and retro/antegrade phlebography was perfumed.

According to non invasive and invasive examination methods – Chronic venous disease C1,2 (CEAP) I83.9; Post Thrombotic Syndrome I87.0; Varicose veins of pelvis I86.2.

The futility of medical therapy was the reason for the decision to perform endovascular intervention to improve the quality of life and relieve pain.

General anesthesia (Endo tracheal) was recurred. Ultrasound guided Catheterization of both femoral (10 F) and right internal jugular vein (8F) performed. Recanalisation of the inferior vena cava, both ilio-cava segments was performed by retrograde approach with combination of 0.035 gudewire (Terumo RADIFOCUS Glidewire) and support catheter (Quick-Cross Spectranectics). On the right, ilio-caval segment recanalization was only possible through a collateral vessel. The distal end of the guidewires was retracted using snare kit (Ev3 Esnare). Post recanalizacion, PTA of inferior vena cava and ilio-caval segments were perfumed with high pressure non-compliment balloon catheters – inferior vena cava (18x40 mm Atlas Bard), iliac and femoral veins (Left and Right): Mustang Boston Scientific (9x60), Atlas Bard (12x40). Stent implantation in to IVC (Sinus XL Optimed) 18x20 mm was performed. dabble barrel stenting method was chosen to create Iliac “confluence” and Parallel implantation of stents into the iliac right – (Venovo Bard) 16x40 мм, Left – 16x60 мм (Zilver Vena Cook); Implantation of venous stents was finally performed using 14x180 mm Zilver Vena (Cook) 14x40 Venovo (BARD), 14x180 mm Zilver Vena (Cook), bilaterally, along the entire iliac segment;

Results: Final angiography showed satisfaction of venous outflow and absence of the venous collaterals after treatment. Immediate clinical response after treatment was achieved – absence of pain syndrome (in pelvis); According to US data, the ileocaval segment is patent (adequate outflow); Hemodynamic not significant, residual stenosis of the left femoral vein (adequate inflow). Post- intervention patient was on Xarelto (Rivaroxaban) 15 mg (2 b.i.d.) – 21 day, after 20 mg (1 q.d.); Clopidogrel (Plavix) – 0.75 mg (1 q.d.); 3-year follow-up showed patent outflow on both leg venous system and significant improvement of complaints. In US (ultrasound Examination) there is patent implanted venouse stents without signs of intra luminal narrowing.

Conclusion: Chronic iliocaval obstruction is best managed percutaneously. Dedicated venous stents are necessary and early clinical results are promising. In some challenging chronic venous obstructions, recanalization is possible to perform frieuw collateral vassal’s, as well as, dedicated venous stents stent placement is safe, in this way. Additional thinking/research necessary to understand stent performance.