Zürich

• Tuesday, January 28th: 8:50 - 9:10, Room 2 - Main Arena 2

  Case 09 – Pelvic congestion syndrome

  Center:

  Zürich

  Case 09 – ZUE 01: female, 38 years (B-S)

  Operators:

  • Nils Kucher,
  • Dai-Do Do,
  • F. Baumann

  CLINICAL DATA
  Left lower abdominal pain radiating to left proximal thigh; aggravated by menstrual cycle
  Painful varicose veins vulva and left thigh
  Left-sided venous claudication
  
  IMAGING
  Ultrasound & MR findings:
  - May-Thurner compression
  - Retrograde flow left internal iliac vein
  - No evidence for nutcracker anatomy
  - Left pudendal vein feeding varicose thigh veins
  
  PROCEDURAL STEPS
  1. Local anesthesia left groin, supine position
  2. Ultrasound-assisted venous access (common femoral vein), insertion 10F sheath
  3. Phlebography / IVUS
  4. Sinus obliquus stent (OPTIMED)

  View image
• Tuesday, January 28th: 11:20 - 11:40, Room 2 - Main Arena 2

  Case 13 – Heart failure and post-thrombotic syndrome

  Center:

  Zürich

  Case 13 – ZUE 02: male, 66 years, (P-vM)

  Operators:

  • Nils Kucher,
  • Dai-Do Do,
  • F. Baumann

  CLINICAL DATA
  High-risk PE requiring CPR and systemic thrombolysis following hernioplasty, 03/2019
  Complications: active retroperitoneal bleeding, sepsis, renal failure, IVC Optease filter thrombosis with massive bilateral DVT of entire deep veins below the IVC filter
  Current medical condition: Dyspnea NYHA II-III, post-thrombotic syndrome with permanent leg swelling and venous claudication (particularly left side)
  
  IMAGING
  Echocardiography 11/2019: Normal LV function, normalized RV size and function, no indirect signs of pulmonary hypertension
  Ultrasound 11/2019 and Chest-CT 07/2019: Patent common femoral veins, patent external iliac veins, post-thrombotic common iliac veins, occluded infrarenal IVC, patent suprarenal IVC
  
  PROCEDURAL STEPS
  Cardiopulmonary exercise test 11/2019: Max VO2: 53%
  
  PROCEDURAL STEPS
  1. General anesthesia, urinary catheter, supine position
  2. Ultrasound-assisted access from:
  bifemoral
  – common femoral vein: left 10F sheath, right 16F sheath
  right jugular vein
  – 10F sheath
  3. Angioplasty of iliac veins and infrarenal IVC
  4. Extraction Optease Filter
  5. Reconstruction IVC and iliac veins
  – Venovo stents (BARD/ BD)

  View image
• Tuesday, January 28th: 16:30 - 18:00, Room 2 - Main Arena 2

  Case 15 – Pelvic congestion and post-thrombotic syndrome

  Center:

  Zürich

  Case 15 – ZUE 03: female, 43 years (S-K)

  Operators:

  • Nils Kucher,
  • F. Baumann

  CLINICAL DATA
  Pregnancy-induced right-sided iliofemoral DVT 01/2018
  Conservative treatment with LMWH and compression stockings
  Persistant venous claudication and leg swelling as well as lower abdominal pain with aggravation during menstruation cycle
  Endovascular reconstruction of right ilio-femoral veins 11/2019 using Venovo & BlueFlow stents
  
  PRESENT STATE
  Follow-up in outpatient clinic 12/2019:
  Leg symptoms completely resolved
  Lower abdominal pain unchanged
  
  IMAGING
  Duplex: confirmed patency of venous stents
  MR-imaging: enlarged ovarian veins
  
  PROCEDURAL STEPS
  1. Local anesthesia right jugular vein, supine position
  2. Ultrasound-assisted access
  – 5F sheath
  3. Venography of ilio-femoral stents
  4. Selective Valsalva venography left ovarian and parauterine veins
  – 5F Kobra catheter (COOK)
  5. Selective injection of Aethoxysclerol (3%) foam to parauterine veins during Valsalva
  6. Coil embolization of left ovarian vein
  – Nester 12 mm coils (COOK)
  7. Final venogram to confirm ovarian vein occlusion
  

  View image