PMC6319535_01
Axial CT of a 50-year old male presenting with bilateral lower extremity edema and pain. Torturous collaterals connecting the great saphenous veins immediately proximal to the saphenofemoral junctions are noted coursing through the anterior pelvic wall adipose tissue (white arrow)
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Fig1
Computed tomographic (CT) venography of the abdomen/pelvis demonstrated a markedly tortuous collateral vein coursing through anterior pelvic wall fat, connecting the great saphenous veins immediately proximal to the saphenofemoral junctions (Fig. 1).
Digital subtraction venography demonstrating complete occlusion of the left common iliac vein and collateralization. The site of occlusion is identified (white arrow). Contrast injected ipsilateral and distal to the lesions is seen draining to the contralateral common iliac vein (red arrow) through the dominant left-to-right sapheno-saphenous collateral drainage pathway (black arrow)
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Fig2
Venography demonstrated occlusion of the left common and external iliac veins with dominant drainage via a left to right sapheno-saphenous collateral (Fig. 2).
Post-stenting venography. Brisk flow is demonstrated through the stented occlusion. Drainage through the sapheno-saphenous collaterals is no longer observed
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Fig3
AZ). Completion venography demonstrated brisk flow through the recanalized segment and cessation of flow across the sapheno-saphenous collateral (Fig. 3). CT venography performed at one month demonstrated stent patency; the patient's edema improved and pain resolved. The post-operative VCSS for the patient was 2, indicating that the procedure enhanced the patient's quality of life. After the procedure the patient began a daily anticoagulation regimen of aspirin 81 mg and clopidogrel 75 mg indefinitely.
PMC6319535_02
Axial CT of a 55-year old woman presenting with bilateral lower extremity edema and pain. Torturous collaterals connecting the great saphenous veins are noted coursing through the anterior pelvic wall adipose tissue (white arrow)
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Fig4
CT venography revealed chronic occlusion of the left iliac vein with cross pelvic collaterals draining into the right common femoral vein (Fig. 4).
Digital subtraction venography demonstrates near total occlusion of left iliac vein. Near total occlusion of the left iliac vein (red arrow). Dominant drainage is observed through a left-to-right sapheno-saphenous collaterals (black arrow)
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Fig5
A large left to right sapheno-saphenous bypass collateral was identified, along with retroperitoneal and pelvic collaterals (Fig. 5).
Post stent venography. Brisky flow is demonstrated through the stented iliac vein (black arrow). Drainage through lumbar and sapheno-saphenous collaterals are no longer seen
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Fig6
Flow through the sapheno-saphenous collateral was no longer visualized (Fig. 6).