Successful stenting of a complex inferior vena cava stenosis using a modified sharp recanulization technique

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Hepatology

Background:

• Noncirrhotic portal hypertension can stem from inferior vena cava (IVC) obstruction.
• Chronic total occlusion of the IVC is a challenging condition to treat.
• Diagnosis and management require advanced imaging and interventional techniques.

Purpose of the Study:

• To present a unique case of noncirrhotic portal hypertension caused by IVC obstruction.
• To describe a novel technique for recanalizing and stenting a long-segment, chronic total IVC occlusion.
• To highlight the utility of combined ultrasound and fluoroscopic guidance in complex IVC interventions.

Main Methods:

• A 30-year-old male with noncirrhotic portal hypertension underwent diagnostic IVC angiography and ultrasound.
• A long-segment (36 mm), chronic total thrombotic IVC occlusion was identified.
• A modified sharp recanalization technique using a Brokenborough needle and Mullin dilator was employed under simultaneous ultrasound and fluoroscopic guidance, followed by stenting.

Main Results:

• The recanalization and stenting procedure resulted in a satisfactory outcome.
• The modified technique allowed for successful creation of a track through the chronic total occlusion.
• The patient's condition was managed effectively with the described interventional approach.

Conclusions:

• Inferior vena cava (IVC) obstruction should be considered in noncirrhotic portal hypertension.
• A modified sharp recanalization technique is effective for treating long-segment, chronic total IVC occlusions.
• Combined ultrasound and fluoroscopic guidance enhances the safety and success of complex IVC interventions.