IVC tube graft. While the #IVC can be ligated below the ren | Figure 1

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IVC tube graft

IVC can be ligated below the renal veins, injury to the suprarenal IVC requires reconstruction. Here the greater saphenous vein is splayed opened lengthwise and sewn together in a spiral fashion over a chest tube to create the graft. Synthetic graft is too thrombogentic to be used in vein reconstruction.

Case Information

1. Rare
2. • Q1: f - All of the above.
   • Q2: d - 30% per JAHA 2017 study.

The filter was unable to be retrieved utilizing a traditional snare so the decision was made to abort further attempts of filter retrieval at that time. The patient returned 11 days later for repeat attempt at filter retrieval with a laser excimer sheath to circumferentially ablate the fibrotic tissue and permit filter retrieval with subsequent iliocaval reconstruction.

• Fellow: Lauren Evans, MD
• Attending: Doug McDonald, MD
• Program/Dept(s): Interventional Radiology Department, Scott & White Hospital, Temple, TX

3.

• Ruptured varicose vein in calf

4.

• IVC thrombosis has developed below indwelling OptEase IVC filter, extending below the common iliac veins. A plethora of abdominopelvic collateral pathways have developed.
  • IVC thrombosis can lead to lower extremity DVT, chronic venous insufficiency, post-thrombotic syndrome, and limb ischemia.
  • Recurrent VTE after adequate anticoagulation, VTE with contraindications to anticoagulation, VTE with complication from anticoagulation, and inability maintain anticoagulation for VTE.

Lower extremity symptoms from venous hypertension were treated with IVC filter retrieval followed by cavo-iliac reconstruction. Venography of the common iliac veins and IVC demonstrates occlusion at the cavo-iliac bifurcation with prominent collateral pathways. Note indwelling IVC filter. The IVC filter was successfully recaptured with using a laser excimer sheath.

Next, a Gianturco stent was deployed just inferior to the right renal vein, followed by an overlapping Gianturco stent in the peripheral IVC. Kissing Wall-stents were deployed at the cavo-iliac bifurcation. Completion venography demonstrates patent IVC and common iliac veins with preferential blood flow through the reconstructed iliocaval system.

Case courtesy of Dr. Doug McDonald and Dr. Lauren Evans from Scott and White Medical Center, Department of Interventional Radiology, Texas A&M University.

• Subclavicular approach with #pseudoaneurysm exposure, proximal and distal arterial control, opening of the pseudoaneurysm, controlling bleeding from the union by means of foley catheter balloon. Axillary vein ligation and #revascularization of the limb by #PTFE prosthetic graft of 6 mm diameter, axillo-axillary in terminal-terminal form.