LINC 2015 live case guide

Galway

• Tuesday, January 27th: 9:15 - 9:30, Main Arena 2

  Case 12 – Acute ilio-femoral deep vein thrombosis

  Center:

  Galway

  Case 12 – GAL 01: male, 56 years old - carpenter

  Operators:

  • Gerard O'Sullivan,
  • Jean Marc Pernes,
  • Tony Lopez
• Tuesday, January 27th: 9:45 - 10:00, Main Arena 2

  Case 14 – Endovascular treatment of a complex recurrent thrombosis

  Center:

  Galway

  Case 14 – GAL 02: female, 41 years

  Operators:

  • Gerard O'Sullivan,
  • Jean Marc Pernes,
  • Tony Lopez

  CLINICAL DATA
  Unusual presentation in 2008 with supra-renal IVC thrombosis and extensive right lower extremity DVT
  Suprarenal IVC filter placed
  Successfully treated by catheter directed thrombolysis and placement of tandem 12mm diameter, 90mm long Wallstent
  Patient could not tolerate balloon dilatation beyond 10 mm
  Fully anticoagulated
  Lost to follow up; represented in 2013 with varicose veins RLE. CEAP 4
  
  PROCEDURAL STEPS
  1. General anaesthetic, urethral catheter, supine position
  
  2. Mid thigh femoral venous access
  - 5F sheath; ascending venography
  - R IJV access; 55cm long sheath; 8F
  - 5000u IV Heparin
  - Upsize to 10F sheath R FV
  
  3. Attempt to cross occluded stent in R EIV from below and if necessary above
  - Stif glidewire; back end stiff glidewire; centring balloon technique CTO wire (Asahi Astata 30g with 2.5 mm balloon to back it up).
  - IF we get across; attempt to clear out stent with Rotarex (STRAUB MEDICAL).
  
  4. Exchange for a 180cm Amplatz wire
  - Pre dilate lesion with a high pressure balloon (BARD Atlas).
  - Stent lesion with a dedicated venous stent
  Veniti Vici 16 mm diameter, 120 mm long
  
  5. Repeat balloon dilatation to nominal diameter of stent
  - Confirm full stent expansion by IVUS (VOLCANO) and cone beam CT (SIEMENS).
  - Completion venography
  
  6. Radiofrequency ablation
  - IF ALL ABOVE SUCCESSFUL then; radiofrequency ablation to R GSV throughout its length (ClosureFast, COVIDIEN).
  
  7. Remove sheaths
  - Class 2 thigh high compression stockings (Jobst) for 6 weeks.
  - Full anticoagulation
  - Overnight thigh high sequential compression device (COVIDIEN).
  - Colour Doppler US day 1; CTV at 6/52

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• Tuesday, January 27th: 16:30 - 18:00, Main Arena 2

  Case 23 – Ovarian and internal iliac vein embolization

  Center:

  Galway

  Case 23 – GAL 04: female, 36 years

  Operators:

  • Tony Lopez,
  • Gerard O'Sullivan,
  • Jean Marc Pernes

  CLINICAL DATA
  Noticed development of vulval varices after birth 2nd child and became much worse after third. Uncomfortable. Unpleasant.
  
  PROCEDURAL STEPS
  1. Local anaesthetic, no sedation
  
  2. S upine position
  
  3. R IJV access
  
  4. S elective catheterisation right ovarian, left ovarian and bilateral internal iliac veins
  
  5. Combination of foam sclerosant and coil (COOK) embolisation
  
  6. Deliberate dissection orifice right ovarian vein!!

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