Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct;35(4):333-341.
doi: 10.1055/s-0038-1669963. Epub 2018 Nov 5.

Endovascular Therapy for Lower Extremity Chronic Deep Venous Occlusive Disease: State of Practice

Vibhor Wadhwa  1 , Ravi N Srinivasa  2 , Kyle J Cooper  2   3 , Anthony N Hage  2 , Jacob J Bundy  2 , Brooke Spencer  4 , Venu Vadlamudi  5 , Jeffrey Forris Beecham Chick  2   5
Affiliations
Review

Endovascular Therapy for Lower Extremity Chronic Deep Venous Occlusive Disease: State of Practice

Vibhor Wadhwa et al. Semin Intervent Radiol. 2018 Oct.
No abstract available

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
A 52-year-old female with quadriplegia, factor V Leiden, and antithrombin III deficiency referred for chronic iliocaval thrombosis and phlegmasia. ( a ) Left iliocaval venography demonstrating left common iliac occlusive disease with robust retroperitoneal collaterals. The iliocaval confluence is faintly seen (arrow). ( b ) Bilateral right (arrow) and left (arrowheads) iliocaval venography after blunt recanalization of the left iliac vein. ( c ) Bilateral right (arrow) and left (arrowheads) iliocaval venography after blunt recanalization of the right and left iliac veins. ( d ) Sequential angioplasty of the inferior vena cava was performed using 8 mm × 8 cm Mustang, 14 mm × 6 cm, and 18 mm × 4 cm Atlas balloons. Angioplasty of the bilateral right and left (arrow) common iliac veins was performed using 8 mm × 8 cm Mustang, 14 mm × 6 cm and 16 mm × 4 cm Atlas balloons. ( e ) Iliocaval reconstruction was performed using a 20 mm × 55 mm Wallstent within the inferior vena cava and 14 mm × 90 mm Wallstents within the bilateral common iliac veins. Postdeployment angioplasty was performed. ( f ) Completion venography showing brisk flow throughout the iliocaval venous reconstruction. A flush catheter is seen throughout the right iliocaval segments (arrows).
Fig. 2
Fig. 2
A 46-year-old male with esophageal cancer–associated hypercoagulability and inferior vena cava filter–associated chronic iliocaval thrombosis and left lower extremity ulceration (Clinical, Etiology, Anatomy, and Pathophysiology class 6 disease). ( a ) Bilateral iliocaval venography demonstrates chronic thrombotic changes throughout the iliac vein and inferior vena cava (arrow). Multiple lumbar and retroperitoneal venous collaterals are seen. ( b ) Fluoroscopic image showing a Denali inferior vena cava filter (arrow) causing chronic filter-associated iliocaval thrombosis. ( c ) The Denali inferior vena cava filter (arrow) was removed using the standard Cook retrieval set (arrowheads). ( d ) Angioplasty of the inferior vena cava using a 14-mm high-pressure balloon (arrow). ( e ) Angioplasty of the inferior vena cava using an 18-mm high-pressure balloon (arrow). ( f ) A 20 mm × 55 mm Wallstent was deployed in the inferior vena cava and 14 mm × 60 mm Wallstents were placed within the common iliac veins. Completion venography demonstrated robust in-line venous flow throughout both iliac veins. ( g ) Venography demonstrated in-line flow throughout the inferior vena cava.
Fig. 3
Fig. 3
A 61-year-old male with methylenetetrahydrofolate reductase and smoking history with inferior vena cava filter–associated chronic iliocaval thrombosis and left lower extremity pain and swelling (Clinical, Etiology, Anatomy, and Pathophysiology class 4 disease). ( a ) Right iliocaval venography demonstrated venous irregularity consistent with chronic iliocaval thrombosis of the right iliocaval segment (arrow). ( b ) Initial attempts to cross the inferior vena cava filter–associated iliocaval thrombosis using a glidewire and glide catheter (arrow) were unsuccessful. ( c ) Fluoroscopic image demonstrating the Trapeze inferior vena cava filter (arrow) causing chronic filter-associated iliocaval thrombosis. Sharp recanalization was performed using a BRK needle and a loop snare. ( d ) Attempts to remove the inferior vena cava filter were unsuccessful. Angioplasty across the inferior vena cava filter was performed using a 4-mm Sterling balloon (arrow). ( e ) The infrarenal inferior vena cava was angioplastied using an 18-mm balloon) ( f ) A 20 mm × 55 mm Wallstent was deployed in the inferior vena cava and 12 mm × 90 mm Wallstents were deployed in the common iliac veins (arrows). ( g ) Completion venography demonstrated a briskly filling iliocaval reconstruction with Trapeze inferior vena cava filter sequestration (arrow).
See this image and copyright information in PMC

References

    1. Raju S. Treatment of iliac-caval outflow obstruction. Semin Vasc Surg. 2015;28(01):47–53. - PubMed
    1. Williams D M. Iliocaval reconstruction in chronic deep vein thrombosis. Tech Vasc Interv Radiol. 2014;17(02):109–113. - PubMed
    1. de Graaf R, de Wolf M, Sailer A M, van Laanen J, Wittens C, Jalaie H. Iliocaval confluence stenting for chronic venous obstructions. Cardiovasc Intervent Radiol. 2015;38(05):1198–1204. - PMC - PubMed
    1. Neglén P, Raju S. Balloon dilation and stenting of chronic iliac vein obstruction: technical aspects and early clinical outcome. J Endovasc Ther. 2000;7(02):79–91. - PubMed
    1. Neglén P, Darcey R, Olivier J, Raju S. Bilateral stenting at the iliocaval confluence. J Vasc Surg. 2010;51(06):1457–1466. - PubMed