Endovascular reconstruction of an interrupted inferior vena cava.
BACKGROUND
Inferior 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.


METHODS
We 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.


CONCLUSIONS
Endovascular 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.


CONCLUSIONS
Endovascular stents may be used safely and effectively to reconstruct the surgically interrupted inferior vena cava in the treatment of chronic venous insufficiency.
Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia. Electronic address: shannondthomas@gmail.com.
Shannon D
SD
Thomas
Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.
Adam
A
Ofri
Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.
Tjun
T
Tang
Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
Raymond
R
Englund
Angioplasty; Chronic venous insufficiency; Endovascular; IVC; Stents; Venous