Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure

Abstract

Background Post-thrombotic syndrome due to chronic venous occlusion is associated with high morbidity and healthcare costs. Sharp venous recanalization has been used with success when conventional techniques fail to cross the occlusion, permitting endovascular reconstruction with angioplasty and stenting. However, manipulation of a needle, especially in extra-anatomic locations, risks damage to adjacent structures, thus necessitating adequate imaging guidance. Case presentation This report describes the novel use of hybrid CT-angiography in a successful recanalization of a complex iliofemoral chronic venous occlusion, after multiple failed attempts with traditional recanalization techniques. The procedure was performed without complications, and stent patency was confirmed at three-month follow-up with patient-reported improvement in severe post-thrombotic syndrome. Conclusions This case demonstrates effective incorporation of hybrid CT-angiography to facilitate complex sharp venous recanalization for chronic lower extremity thrombosis, as an alternative to standard fluoroscopic techniques requiring multiple projections with or without cone-beam CT. Further studies are needed to understand the implications of this strategy.

XperCT facilitates sharp recanalization for the treatment of chronic thoracic venous occlusive disease in hemodialysis patients

“…The use of CT-guided sharp recanalization has been reported for the treatment of chronic vascular occlusive diseases in the lower extremities as well as for CVOD. 9,12,13 Knowing the precise 3D structure of an occlusive lesion greatly assists in recanalization as well as can increase the operator's confidence. For occluded veins, the operator can base his navigation on the virtual centerline obtained from 3D images overlaid on 2D fluoroscopy images.…”