Abstract
Though endovascular interventions for venous obstructive lesions have evolved, chronic total occlusions are difficult to negotiate. We are describing our experience of successfully using modified sharp recanalization technique in which the Brockenbrough needle in the Mullin sheath was used to negotiate the chronic total occlusion of inferior vena cava in a case in which the lesion was not crossed with repeated attempts with a guide-wire. Finally the lesion was predilated with mitral valvuloplasty balloon. A balloon-mounted stent was deployed with optimum postprocedural results. At the follow-up of 6 months, the patient was asymptomatic with optimal clinical outcome in form of patent stent on Doppler and computed tomography studies.
Highlights
Chronic total occlusion (CTO) of inferior vena cava (IVC) may be totally asymptomatic or may present with myriad of signs and symptoms, depending on the level of obstruction and collateral venous drainage
Symptoms associated with the IVC obstruction, often referred to as “IVC syndrome”, can be debilitating including lower extremity pain, edema, venous congestion and skin changes like venous ulcers and eczema
Success rate is comparatively lower in revascularization of CTO in stenotic lesions [4]
Summary
Chronic total occlusion (CTO) of inferior vena cava (IVC) may be totally asymptomatic or may present with myriad of signs and symptoms, depending on the level of obstruction and collateral venous drainage. His thrombophilia workup including coagulation parameters; antithrombin 3, protein C and S levels; anticardiolipin antibodies, lupus anticoagulant, prothrombin and Leiden gene mutations, and platelet count were within normal limits except hyperhomocystinemia (>15 mg/L). He denied history of trauma or surgery to abdomen or pelvis. Catheter-based venogram was planned to determine the further line of management
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