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Sigmoid sinus thrombosis associated with internal jugular venous occlusion: direct thrombolytic treatment
M B Gurley1, T S King, F Y Tsai
1Department of Radiology, Truman Medical Center, University of Missouri, Kansas City School of Medicine, Kansas City 64108, USA.
Insights
Direct venous thrombolysis and angioplasty effectively treated internal jugular vein and sigmoid sinus thrombosis in two patients. This minimally invasive approach resolved symptoms and addressed underlying venous stenosis, offering a viable treatment option.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Neurology
Background:
- Central venous and dural sinus occlusions, particularly internal jugular vein and sigmoid sinus thrombosis, are rare but serious conditions.
- Traditional treatments may be limited, necessitating advanced endovascular techniques.
Observation:
- Two middle-aged women presented with symptomatic internal jugular vein and sigmoid sinus thrombosis.
- Diagnosis was confirmed via venography, utilizing a transfemoral approach.
Findings:
- Direct transfemoral venous thrombolysis with urokinase achieved successful recanalization of occluded sigmoid sinuses and internal jugular veins in both patients.
- One patient also required balloon angioplasty to treat an underlying venous stenosis, preventing recurrence.
- Clinical symptoms resolved completely in both cases post-intervention.
Implications:
- Transfemoral direct venous thrombolysis is a safe and effective treatment for central venous and dural sinus occlusions.
- Angioplasty is crucial for addressing underlying stenosis to minimize the risk of thrombotic recurrence.
- This approach offers a minimally invasive alternative for managing complex venous thrombotic events.
Purpose:
To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis.
Methods And Results:
Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent "burst-bolus" technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients.
Conclusions:
Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.