Transjugular approach for successful recanalization and stenting for inferior vena cava stenosis
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CASE REPORT
Transjugular approach for successful recanalization and stenting for inferior vena cava stenosis Budanur Chikkaswamy Srinivas • Ajit Pal Singh • C. M. Nagesh • Babu Reddy C. Nanjappa Manjunath
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Received: 14 November 2012 / Accepted: 13 February 2013 / Published online: 24 February 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Budd-Chiari syndrome is a rare disease characterized by obstruction of outflow in the hepatic vein and/ or the inferior vena cava (IVC). Percutaneous transluminal angioplasty and stent placement is nowadays considered to be the first-line treatment for central venous disease because of its minimal-invasive approach. IVC reconstruction by surgical approach is not preferred due to increased morbidity and disappointing patency rates. We describe a case of a long-segment, thrombotic, chronic total occlusion of the IVC that was dilated and stented using a recanalization technique involving the use of Brokenborough septal puncture needle, Mullin dilator and Accura balloon from the jugular approach. Keywords Balloon dilatation IVC obstruction IVC stenting IVC venography Brokenborough needle
Introduction Budd-Chiari syndrome (BCS) refers to a group of disorders with obstruction of hepatic venous outflow involving one or more draining hepatic veins or the inferior vena cava (IVC). Restoration of hepatic venous flow through the
Electronic supplementary material The online version of this article (doi:10.1007/s12928-013-0169-9) contains supplementary material, which is available to authorized users. B. C. Srinivas A. P. Singh (&) C. M. Nagesh B. Reddy C. N. Manjunath Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru 560069, India e-mail: [email protected]
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hepatic veins or the IVC using surgical or percutaneous approach is the most physiological way to treat the disease. With the advent of percutaneous balloon angioplasty (PTA) and stent, and a fairly good midterm outcome, surgery no longer remains the standard of care for BCS [1, 2]. We describe a case of a long-segment, thrombotic, chronic total occlusion (CTO) of the IVC that was dilated and stented using a recanalization technique using the jugular approach.
Case report A 25-year-old male patient complained of progressive abdominal distention, swelling of both feet, and visible veins over abdomen. Venous Doppler study suggested obstruction of the hepatic part of IVC which was confirmed with CT. Subsequent IVC angiogram revealed a long CTO of the intrahepatic IVC associated with aneurysm (Figs. 1, 4, Video 1). A stiff Terumo wire (Terumo Medical Corporation, Somerset, NJ, USA) failed to cross the lesion via femoral vein. Because a small dissection was made in the IVC from femoral approach, the procedure was abandoned. Hence in the next sitting, we tried the procedure via jugular vein using a Brokenborough SP needle to negotiate the upper blind end of the lesion with the help of 7 Fr Mullin dilator. The needle was gentl
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