Venous Stenting

FIRST CASE OF STENT RECONSTRUCTION OF AN OCCLUDED INFERIOR VENA CAVA
AND BOTH COMMON ILIAC VEINS
Performed June 6, 1990

	A) Occluded IVC and common iliac B) After UK infusion

A 55 year old man with six year history of retroperitoneal fibrosis, right sided retroperitoneal mass, and two surgeries for bilateral ureteral obstructions. In last few months he noted increasing lower extremity edema which recently became massive and extended into groin area and scrotum.

Pelvic venogram performed by simultaneous injections of contrast medium into external iliac veins revealed occlusion of the IVC and both common iliac veins with filling of paravertebral collaterals.

A 28 hour local Urokinase infusion using a total dose of 5,630,000 units completely lysed the thrombi and follow up pelvic venogram revealed severe irregular narrowing of the IVC.

	A) After stent placement B) Five month follow up venogram

The narrowed IVC and the common iliac veins were reconstructed with the Gianturco-Rösch Z-stents. A five segment stent (12.5 cm long and 2 cm wide) was used for reconstruction of IVC. A three segment stent (5 cm long and 2 cm wide) was put in the right common iliac vein.

The patient's swelling resolved in seven days and a follow up venogram five months after stent placement showed excellent patency of the stented veins with only minimal intimal hyperplasia.

The patient has been doing well on a low dose of warfarin without recurrence edema for 18 years.