PMC6319511_01
Non-contrast CT images through (a) the lower pelvis and (b) upper thighs demonstrating a large obstructing right pelvic tumor (open arrow), significant right-sided subcutaneous edema (arrows), and marked limb asymmetry due to right limb edema
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Fig1
A non-contrast CT scan of the abdomen and pelvis revealed an increase in the size of a pelvic retroperitoneal nodal mass inseparable from the right common iliac artery and right ureter, with no clear visualization of the right iliac venous system (Fig. 1).
a Venography through the right popliteal venous access demonstrates complete occlusion of the native right iliac veins and extensive collateralization. b the tip of a 0.018'' wire inserted though the common iliac artery ends in the lower aorta (solid arrow). A transjugular metal cannula with a coaxial 21-gauge Chiba needle (dotted arrow) is inserted through the right common femoral vein and is about to enter the IVC which contains a semi-inflated balloon inserted through the internal jugular vein (open arrow). c The tip of a 0.018-in. wire (arrow) inserted through the created channel now ends in the IVC alongside the inflated balloon (open arrow). d Kissing stents were placed through the right femoral vein and internal jugular vein access
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Fig2
Venography showed extensive thrombosis and strictures of the right common iliac, right external iliac, and right femoral veins with collateralization (Fig. 2a). The metal cannula was then progressively advanced towards the target balloon in the lower IVC. A 21-gauge Chiba needle was advanced through the cannula (Fig. 2b). The needle and a 0.018-in. guidewire were used to create a channel through the encasing tumor into the caudal segment of the IVC with one pass (Fig. 2c). Three additional overlapping stents [one 16 mm x 90 mm Wallstent; two 14 mm x 60 mm S.M.A.R.T stents (Cordes, Fremont, CA)] were placed from the right common iliac to the right common femoral vein followed by balloon angioplasty (Fig. 2d).
Completion venography shows widely patent right iliac vein stents with free contrast flowing into the IVC
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Fig3
Completion venography demonstrated widely patent stents with contrast flowing into the IVC (Fig. 3).