Endovascular reconstruction of an interrupted inferior vena cava

Abstract

INTRODUCTIONInferior vena cava (IVC) interruption was established as a procedure to treat refractory venous thromboembolism (VTE) complicated by pulmonary embolism. Ilio-caval thrombosis and lower limb chronic venous insufficiency (CVI) are well known long-term complications of IVC interruption, where subsequent treatments may carry significant morbidity and mortality.PRESENTATION OF CASEWe present here a case of chronic venous insufficiency resulting from IVC interruption with a vascular clip placed forty years previously. A novel approach utilising endovascular stents was used to reconstruct the iliocaval confluence and interrupted distal IVC without the need for laparotomy to remove the plicating clip. This procedure was associated with minimal morbidity and resulted with a quick resolution of the patient's CVI symptoms.DISCUSSIONEndovascular angioplasty and stenting is an alternative to open reconstruction of the interrupted inferior vena cava. We have demonstrated successful opening of a plication vascular clip using only endovascular utilities. Advantages include a shorter hospital stay, and reduced morbidity and mortality when compared to a re-do laparotomy.CONCLUSIONEndovascular stents may be used safely and effectively to reconstruct the surgically interrupted inferior vena cava in the treatment of chronic venous insufficiency.

Vena cava inferior agenesis recognized by incidentally in a patient under cholecystectomy

“…Also, thrombectomy can be performed with invasive procedures in cases with acute DVT. There are cases undergoing endovascular reconstruction and prosthetic graft interposition for interrupted IVC anomaly (19,20).…”

Feasibility of Endovascular Recanalization in Post-Thrombotic Syndrome of Intentionally Interrupted Inferior Vena Cava

“…Percutaneous recanalization with angioplasty and stenting have progressively replaced open surgery, becoming the current method recommended to treat post-thrombotic syndrome (PTS) [5]. Whereas endovascular recanalization of thrombosed filter bearing IVCs has been previously widely described [6][7][8][9][10][11][12], the potential to recanalize intentionally interrupted IVC has been described in only few case reports [13,14], and only once dealing specifically with external clipping [14]. This study aims to assess the feasibility and safety of endovascular recanalization to open the clip and reconstruct iliocaval confluence after vena cava plication.…”

Evaluation of a Bioabsorbable Self-Expandable Vein Stent-Base Made of Poly(l-lactide) In Vitro and In Vivo

“…There are numerous studies on the bioabsorbable vascular devices for arterial use, but not for venous applications. Previous work on bioabsorbable stents focused on balloon expandable designs with an outer diameter (OD) of 3-10 mm [ 4,5,6,7,8,9,10,11 ] for arterial indications and, therefore, is not applicable for large veins [ 12 ]. Within the available bioabsorbable polymers, poly L Lactide (PLLA) possesses some appropriate mechanical properties and degradation rate for vascular devices.…”