PMC5291565_01
A, Initial venography in the prone position shows femoral vein thrombosis. B, A venography shows occlusion of the common iliac vein and collateral formation. C, The venography shows a patent common femoral vein and little residual thrombus was shown after manual aspiration thrombectomy. D, The common iliac vein was dilated with an angioplasty balloon. E, A venography after stent deployment shows a patent common iliac vein, good antegrade flow, and abolition of collaterals.
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Venography revealed the following: numerous irregular filling defects in the left popliteal, superficial femoral, and external iliac veins (Figure 1A); occlusion in the common iliac vein; numerous connections between the collateral vessels and contralateral iliac vein in the pelvis (Figure 1B); and backflow of contrast agent through the pelvic collateral veins from the right iliac vein. By using a 50-mL syringe, manual aspiration thrombectomy was performed repeatedly under vacuum, from the iliac vein proximal to the femoral vein, until venography revealed that blood flow in the left femoral and external iliac veins had been restored (Figure 1C). A 10/40-mm balloon catheter (Advance, Cook, Denmark) was inserted through the guide wire to dilate the occluded segment of the iliac vein for approximately 30 seconds (Figure 1D). Venography revealed that the condition of the stent was satisfactory, with good expansion and blood flow (Figure 1E).