Venous Chronic Total Occlusion

Physician

Noah J. Jones, MD, MPH, FSCAI
Interventional Cardiology
Vascular Medicine and Endovascular Interventions
North Cascade Cardiology
Bellingham, Washington

Background

A 45 year old female presented with a history of a previously diagnosed (5 months prior) large left iliofemoral DVT. The patient was taking oral contraception for menorrhagia. The patient had been treated with warfarin and compression stockings, but continued to complain of lifestyle limiting post-thrombotic syndrome (PTS) with left lower extremity venous claudication. Duplex ultrasound assessment revealed a left femoral vein chronic total occlusion (CTO) which reconstituted at the proximal femoral vein and a CTO of the left common and external iliac veins. May-Thurner Syndrome was suspected.

Procedure

The patient was brought to the interventional suite and an IVC filter was placed via the right transfemoral CFV. Initial attempt at femoral vein CTO recanalization from the left popliteal vein approach was unsuccessful due to the inability to cross the occlusion.

The patient was brought back the following day to attempt a left iliac vein CTO recannalization from the right internal jugular approach. This approach was successful.

A 120cm x 30cm Trellis®-8 Peripheral Infusion System was run for 20 minutes, with 8mg of t-PA infused between the two isolation balloons. Following the adjunctive technique of manual aspiration, PTA and stenting, patency with antegrade flow was restored to the venous system.

Conclusion

Continued patency was observed 3 months post-procedure. Complete resolution of the venous claudication symptom of PTS was achieved.