مداخلات عروق محیطی و اندوواسکولار

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Case Of The Week

A 24 years old lady with previous stenting of Common iliac vein presented with recurrent limb edema. Sonography revealed In stent occlusion so she scheduled for venography. Herein the venography result shows

The condition is ISR of CIV. This pathology is common after stenting in venous system. Indeed in 20-40% of post stent patients, in stent re-thrombosis within 6 months. We decided to perform Balloon dilation first and perform CDT if was needed

As you can see there is thrombus in the stent. Since stenting had performed a month ago it was not unexpected. We did CDT in order to achieve better luminal flow and reduce the clot burden. An infusion catheter ed and 4mg/h of Alteplase infused for 6 hours. The below image shows result after CDT.

The result was acceptable but thrombus-suction and ballooning was done for optimum result

Discussion

Venous in stent re-thrombosis/restenosis is not an uncommon entity. Especially in acute DVT and reduced Inflow conditions it is more common. This patient had a suitable inflow and also was not an acute case. In observational studies it\'s rate is about 20-40% which is not uncommon as well. By the way there is not a known optimal treatment for this condition. CDT plus ballooning with or without stenting was have been introduced and because we were not confident with re-stenting we preferred to choose no to stent

کلیه حقوق متعلق به بیمارستان قلب شهید رجائی می باشد | طراحی وب سایت : ACACO