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Chronic Deep Venous Thrombosis management (DVT chronic)

Case of the Month: March 2018

This 30 minutes interactive procedure concerns a 68 years old male presenting bilateral venous ulcers. He has a long  history of venous insufficiency with varicose veins surgery 44 years ago and bilateral Deep Vein Thrombosis 11 years ago.

He presents actually  bilateral iliac veins occlusion.

WATCH IT NOW

Learning points

  • Are chronic venous ulcers curable?
  • How to approach bilateral vein occlusions.
  • How to proceed to recanalize occluded iliac veins.
  • How and where to stent residual vein stenosis.
  • IVUS guided procedure to optimize evaluation and  stent deployment.
  • How to perform bilateral ilio-femoral veins stenting in the same session.

Step-by-Step Procedure

  • Double right internal jugular vein  access  with two 10Fx23cm  introducers.
  • Crossing the Right and Left femoral veins occlusions using Hydrophilic wires and Triforce support catheter.
  • IVUS run for landing zone assessment and sizing.
  • Multilevel predilatation of the right and left systems.
  • Simultaneous Kissing Stenting of the left and the right common iliac veins toward inferior vena cava respecting renal veins origin.
  • Optimizing stent deployment and kissing balloon.
  • Stenting of the  left  common femoral  and external iliac veins with Venovo self-expanding stent and balloon optimizing.
  • Stenting of the right  common femoral  and  iliac veins  with overlapping : Venovo and Vici self-expanding stents.
  • Stenting of the left common iliac vein with overlapping stent.
  • Bilateral IVUS control.
  • Final angiographic result.

Biobliography



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