PMC6319533_01
Initial CT scan showing calcified chronic occluded IVC and abdominal wall collaterals
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Fig1
Cross sectional imaging at that time revealed extensive IVC occlusion (Fig. 1) and multiple dilated collaterals in the soft tissues especially around the area of the upper esophagus.
Pre-recanalization venogram showing completely occluded abdominal IVC and multiple abdominal-pelvic collaterals reconstituting flow through dilated azygos system
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Fig2
IVC using traditional techniques, including sharp recanalization with a variety of hydrophilic wires, catheters, triaxial systems and intravascular needles were unsuccessful. Initial planning venography from right common femoral access showed a completely occluded abdominal IVC and multiple abdominal-pelvic collaterals reconstituting flow through a dilated azygos system (Fig. 2).
Immediate post-recanalization venogram showing widely patent stented IVC with decreased abdominopelvic collaterals, VCF-1 catheter in the aorta, transhepatic GooseNeck snare
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Fig3
Repeat venography demonstrated brisk flow through the recanalized IVC and a marked decrease in the number and sizes of intra-abdominal pelvic collaterals (Fig. 3).
PMC6319533_02
One month follow up venogram showing widely patent IVC stents. Please note the sheath in the hepatic vein prior to deploying a vascular plug
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Fig4
One month later, the patient returned for follow up venography, which demonstrated widely patent stented IVC and removal of the transhepatic permcath (Fig. 4).