PMC3505960_01
Initial diagnostic venography at presentation prior to thrombolysis; left iliac vein.
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fig1
Two infusion catheters were placed under fluoroscopic guidance: one to treat the transplant and juxta-anastomotic iliac veins and the other for the iliofemoral venous system distal to the allograft (done within twelve hours after presentation). (Figure 1).
The x-axis is time (days) and the y-axis serum creatinine values in mg/dL. Elevation of serum creatinine was seen at the time of admission (arrow) which peaked and then gradually returned to baseline after successful thrombolysis, angioplasty, and stent placement.
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fig2
Serum creatinine peaked at 3.14 mg/dL and then gradually returned to baseline after successful thrombolysis, angioplasty, and stent placement (Figure 2). tPA was continued for approximately 2 days.
Intravascular ultrasound (IVUS) in the left iliac vein (anterior at top of image) demonstrating compression from the adjacent right iliac artery (2 o'clock position) before stenting.
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fig3
Intraprocedural intravascular ultrasound (IVUS) of left iliac vein demonstrated compression of left iliac vein between the right iliac artery and vertebra (Figure 3).
Poststent placement intravascular ultrasound (IVUS) in the left iliac improvement in lumen size.
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fig4
Poststent placement IVUS demonstrated improvement in lumen size (Figure 4).
Follow-up venogram demonstrating widely patent iliac vein, stent, and transplant allograft vein.
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fig5
Followup venography at discharge and 3 months later demonstrated complete stent patency without residual thrombus (Figure 5).