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.


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.


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