Pancreas Transplants Venous Graft Thrombosis: Endovascular Thrombolysis for Graft Rescue

Purpose

To retrospectively assess the efficacy and safety of percutaneous endovascular treatment in patients with pancreas venous graft thrombosis (PVGT).

Materials and Methods

Between 2001 and 2009, 206 pancreas transplants were performed at our institution. A retrospective review of pancreas graft recipients who underwent endovascular therapy for PVGT was performed. The study group included 17 patients (10 men, 7 women; mean age 38 years) with PVGT (<60 % [9 patients]; 30–60 % [8 patients]) 6.6 ± 5.7 days after grafting. The angiographic studies, type of endovascular procedure, endovascular procedural and postprocedural effectiveness, and patient and graft outcomes were assessed.

Results

In 16 of 17 cases (94 %), significant (87.5 %) or partial (12.5 %) lysis of thrombi was achieved. One patient had external compression of the portal vein due to a hematoma, which hindered mechanical removal of the thrombi. This patient required graft pancreatectomy for extensive areas of parenchymal necrosis 2 days after the endovascular procedure. No complications related to endovascular treatment were observed. Postprocedural bleeding episodes related to anticoagulation were observed in five patients. Patient and pancreas graft survival rates at 12 months were 94 and 76 %, respectively.

Conclusion

Catheter-directed thrombectomy is an effective treatment for patients with PVGT. Percutaneous thrombectomy, followed by anticoagulation, appears to be an effective therapy to remove the thrombus and is associated with a low complication rate.     

Combined Pharmacomechanical Thrombolysis of Complete Portomesenteric Thrombosis in a Liver Transplant Recipient

Treatment options for portomesenteric venous thrombosis range from anticoagulation to surgery, depending on chronicity, severity of symptoms, extent of thrombosis, and the availability of local expertise. For acute and subacute cases, a variety of endovascular options have been described in limited published series and case reports, including thrombolysis and mechanical thrombectomy. We report what is to our knowledge the first case in which the Trellis pharmacomechanical thrombolysis device was used successfully to treat complete acute thrombosis of the entire superior mesenteric vein and the entire portal vein with extension into all segmental intrahepatic portal branches in a young adult after liver transplantation. This device, coupled with adjunctive techniques using balloon catheters, facilitated complete restoration of flow, resulting in graft salvage and long-term patency.     

门静脉血栓形成的TIPS治疗和临床结果

目的 研究和评价经皮治疗门静脉及其属支血栓的技术可行性和临床效果。方法 16例有门静脉及其属支闭塞症状的患，门静脉及其属支血栓均为非海绵状血管变性所致。通过建立经颈静脉肝内门腔静脉分流通道(TIPS)、带膜支架旁路术和经皮抽吸取栓法清除门静脉及其属支血栓提高门静脉的血流输出量。结果 13例采用经皮技术治疗获得成功。门静脉及其属支血栓所致的门脉高压均得到纠正，静脉曲张破裂出血立即停止；顽固性腹水和黄疸症状得到缓解。结论 经颈静脉门腔静脉分流术、门静脉内带膜支架旁路术和经皮门静脉及其属支抽吸取栓法对于治疗非海绵状血管变性和非瘤栓所致的门静脉闭塞是安全有效的。     

经皮治疗门静脉血栓的临床研究

目的：研究和评价经皮治疗门静脉血栓技术的可行性和临床效果。材料与方法：16例有门静脉闭塞症状的患者,门静脉血栓均为非海绵状血管变性所致。通过建立经颈列脉肝内门腔静脉分流通道（TIPS）,带膜支架旁路术和经皮抽吸取栓法清除门静脉血栓提高门静脉的血流输出量。结果：13例采用经皮技术治疗获得成功。门静脉血栓所致的门脉高压均得到纠正,静脉曲张破裂出血立即停止;顽固性腹水和黄疸症状得到缓解。结论：经颈静脉门腔静脉分流术,门静脉内带膜支架旁路术和经皮门静脉抽吸取栓法对于治疗非海绵状血管变性和晨瘤栓所致的门静脉闭塞是安全有效的。     

Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.     

Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings

The purpose of the article was to prospectively evaluate the MR findings of pancreatic portal cavernoma in a consecutive series of patients with cavernous transformation of the portal vein. This study was approved by the review board of our institution, and informed consent was obtained. The clinical and biological data and the MR imaging for 20 patients (11 female, 9 male; median age, 49 years) with cavernous transformation of the portal vein and no evidence of previous pancreatic disease were reviewed. The presence of pancreatic portal cavernoma (defined as intra- and/or peripancreatic portal cavernoma), morphological changes in the pancreas, biliary and ductal pancreatic abnormalities, and extension of the portal venous thrombosis were qualitatively assessed. Fifteen patients (75%) had pancreatic portal cavernoma with collateral formation in the pancreas and/or collaterals around the pancreas seen on dynamic contrast-enhanced MR sequences: three patients had both intra- and peripancreatic portal cavernoma, six had intrapancreatic portal cavernoma alone and six had peripancreatic portal cavernoma only. The presence of intra- or peripancreatic portal cavernoma was significantly associated with extension of the thrombosis to the splenic and superior mesenteric veins (p = 0.05). Morphological changes in the pancreas, heterogeneity on T2-weighted sequences and main ductal pancreatic abnormalities were seen in two, four and two patients, respectively. All these patients had intrapancreatic portal cavernoma. Bile duct dilatation was observed in 13 (65%) patients: among them three had extrahepatic dilatation only and these three patients had associated intrapancreatic portal cavernoma. In patients with cavernous transformation of the portal vein, intra- or peripancreatic portal cavernoma is common. In conclusion, intra- or peripancreatic portal cavernoma was only observed in patients with extension of the thrombosis to the splenic vein and/or the superior mesenteric vein.     

Successful treatment of delayed aortobifemoral graft thrombosis with manual aspiration thrombectomy

We present a 67-year-old man who had undergone aortobifemoral synthetic graft surgery one year earlier. The patient experienced thrombosis of the graft nine months after the operation, and thrombectomy of the graft was planned. However, the patient refused to undergo repeat surgery for thrombus removal and was referred to our center for possible endovascular treatment. We treated the patient with percutaneous aspiration thrombectomy. The thrombi were chronic in nature but could be removed with minimal residue in any part of the graft by using repeated aspiration thrombectomy with 7 F guiding catheters. Underlying stenosis of both distal graft anastomoses was treated with percutaneous balloon angioplasty, and a self-expanding stent was deployed on the right distal anastomosis. A small fragment of thrombus embolized to the right popliteal artery and was removed with aspiration thrombectomy through a second antegrade puncture on the right side. We believe this is the first report of aspiration thrombectomy for an aortobifemoral graft thrombosis. The method was successful despite the chronic nature of the thrombi. Manual aspiration thrombectomy with largebore guiding catheters can be used as an effective recanalization method for delayed aortobifemoral graft occlusion and could be regarded as a good alternative technique to surgical thrombectomy in selected patients.     

Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series

Cerebral venous sinus thrombosis is an uncommon cause of stroke with high morbidity and mortality rates from venous infarction, intracranial hemorrhage, and extensive cerebral edema. Endovascular treatment with various devices has been proposed as a salvage treatment when standard medical treatment with systemic anticoagulation is ineffective, especially in long segment dural sinus thrombosis. We describe our technique of transvenous endovascular aspiration thrombectomy with large bore thrombectomy catheters, followed by placement of microcatheter for local thrombolytic infusion at the site of thrombosis. We report a retrospective study of angiographic and clinical outcome of six consecutive patients treated with this approach. Endovascular aspiration thrombectomy with large bore catheters followed by continuous local thrombolytic infusion appeared to be a safe and effective salvage treatment for selected patients with cerebral dural venous sinus thrombosis refractory to medical treatment.     

Transjugular Intrahepatic Portosystemic Shunt,Mechanical Aspiration Thrombectomy,and Direct Thrombolysis in the Treatment of Acute Portal and Superior Mesenteric Vein Thrombosis

A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT.     

肝移植术后并发症与介入治疗四、门静脉并发症

肝移植术后门静脉供血障碍性并发症主要为门静脉狭窄和门静脉血栓形成,虽然发生率不高,但临床危害大,一经确诊,需积极处理。彩色多普勒血流显像可作为检测门静脉血流的首选方法,对确诊有功能意义的狭窄还需依赖血管造影。对于门静脉狭窄行球囊扩张术以及支架置入术可有效降低门脉压力,而门静脉血栓形成的病例可用药物溶栓、机械碎栓和支架置放术相结合进行治疗,必要时可行TIPS降低门脉压力。     

Placement of Hemodialysis Catheters Through Stenotic or Occluded Central Thoracic Veins

A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42–80 years), with central venous stenosis or occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography. Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement. Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8–48 months). Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement, respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion, for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates. This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein.     

经腘静脉顺行穿刺治疗下肢静脉血栓的探讨

目的：探讨经腘静脉顺行穿刺治疗下肢静脉血栓的可行性及优越性。方法：下肢静脉血栓患者19例，经对侧股静脉放置下腔静脉滤器后，使用骨科止血带加压成功穿刺腘静脉，15例顺行插管抽血栓，4例使用Amplatz血栓清除器（ATD）。结果：19例均获成功，栓塞血管复通达100％。临床症状消失，无症状性复发。结论：下肢静脉血栓中使用骨科止血带后可有效地提高顺行穿刺腘静脉成功率，是下肢静脉溶栓治疗的有效方法。     

Percutaneous ilio-caval thrombectomy with the Amplatz device: preliminary results

The Amplatz Thrombectomy Device (ATD) is a percutaneous, rotational thrombectomy catheter, capable of recirculating and homogenizing the thrombus in order to obtain mechanical clot dissolution. The authors present their experience with mechanical thrombectomy with the ATD in eight cases of ilio-caval thrombosis. Under temporary caval filter protection, the ATD was introduced through the right transjugular approach (in one patient this was used in combination with the right femoral approach) and activated for a time ranging from 90 to 180 s. Complete clearing of thrombotic material in the treated venous segments was achieved in six cases (75 %), partial success was obtained in one case (12.5 %) and failure occurred in one patient (12.5 %). One patient developed a recurrence of venous iliac thrombosis 1 week after the procedure and postphlebitic syndrome 6 months after the first episode of deep venous thrombosis, and one patient died from acute myocardial infarction, unrelated to thrombectomy session, after 3 days. A negative clinical and radiological follow-up at 3, 6, 12 and 24 months was obtained in the remaining six patients. If a fresh free-floating ilio-caval clot must be removed immediately, the ATD can be effective under temporary filter protection. Received: 5 May 1998; Revision received: 8 June 1998; Accepted: 16 September 1998     

Diagnosis of portal vein thrombosis: value of color Doppler imaging.

This study was undertaken to determine the accuracy of color Doppler imaging in the diagnosis of portal vein thrombosis. Two hundred fifteen patients were studied with color Doppler imaging to determine patency of the main portal vein. Sonographic findings were confirmed in 75 patients, aged 19 to 66 years. Correlation with angiography was obtained in 13 patients, and surgical correlation was obtained in the remaining 62. Nine patients had portal vein thrombosis on the basis of these gold standards. Sonograms were classified as showing either patency or thrombosis, depending on the ability to show color flow within the main portal vein. Agreement between sonography and angiography or surgery was found in 69 patients (61 patent, eight thrombosed). One patient with a patent portal vein at sonography was found to have a thrombosed vessel at surgery, whereas five patients without portal venous flow at sonography had patent vessels at angiography (one patient) or surgery (four patients). Overall sensitivity and specificity for detection of portal vein thrombosis were 89% and 92%, with an accuracy of 92%, a false-negative rate of 0.11, a negative predictive value of 0.98, and a positive predictive value of 0.62. We postulate that the majority of errors in our study occurred in vessels that, although patent, had only sluggish flow, which could not be resolved because of technical limitations. We conclude that color Doppler imaging is a valuable screening procedure for the assessment of portal vein patency. If the sonogram shows a patent portal vein, no further studies are required. However, a lack of demonstrable flow does not always indicate thrombosis, and other imaging studies should be performed for confirmation.     

Transjugular Intrahepatic Portosystemic Shunt and Thrombectomy (TIPS-Thrombectomy) for Symptomatic Acute Noncirrhotic Portal Vein Thrombosis

PurposeTo report the safety and effectiveness of transjugular intrahepatic portosystemic shunt and mechanical thrombectomy (TIPS-thrombectomy) for symptomatic acute noncirrhotic portal vein thrombosis (NC-PVT).Materials and MethodsPatients with acute NC-PVT who underwent TIPS-thrombectomy between 2014 and 2021 at a single academic medical center were retrospectively reviewed. Thirty-two patients were included (men, 56%; median age, 51 years [range, 39–62 years]). The causes for PVT included idiopathic (n = 12), prothrombotic disorders (n = 11), postsurgical sequelae (n = 6), pancreatitis (n = 2), and Budd-Chiari syndrome (n = 1). The indications for TIPS-thrombectomy included refractory abdominal pain (n = 14), intestinal venous ischemia (n = 9), ascites (n = 4), high-risk varices (n = 3), and variceal bleeding (n = 2). Variables studied included patient, disease, and procedure characteristics. Patients were monitored over the course of 1-year follow-up.ResultsSuccessful recanalization of occluded portal venous vessels occurred in all 32 patients (100%). Compared with pretreatment patency, recanalization with TIPS-thrombectomy resulted in an increase in patent veins (main portal vein [28% vs 97%, P < .001], superior mesenteric vein [13% vs 94%, P < .001], and splenic vein [66% vs 91%, P < .001]). Three procedure-related adverse events occurred (Society of Interventional Radiology grade 2 moderate). Hepatic encephalopathy developed in 1 (3%) of 32 patients after TIPS placement. At 1-year follow-up, return of symptoms occurred in 3 (9%) of 32 patients: (a) ascites (n = 1), (b) variceal bleeding (n = 1), and (c) intestinal venous ischemia (n = 1). The intention-to-treat 1-year portal vein and TIPS primary and secondary patency rates were 78% (25/32) and 100% (32/32), respectively. Seven patients required additional procedures, and the 1-year mortality rate was 3% (1/32).ConclusionsTIPS-thrombectomy is a safe and effective method for treating patients with symptomatic acute NC-PVT.     

Mesenteric vein thrombosis: CT identification

Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filing defect. Four of the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. The diagnosis of superior mesenteric vein thrombosis was confirmed by angiography in two patients and by surgery in a third. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis. A dense venous wall surrounding a central lucency representing blood clot was present in all six cases.     

Cerebral Venous Congestion as Indication for Thrombolytic Treatment

Purpose To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent’s effect. Results The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. Eight of these were diagnosed with dural sinus thrombosis only, and had a stable hospital course without worsening of symptoms. These patients also did not have imaging evidence of cerebral venous congestion. The remaining 2 patients had cerebral edema on the CT scan. One had only a small amount of edema in the right cerebellum, but the other had severe edema in the bilateral basal ganglia and thalamic areas. Nine of these patients had a stable hospitalization course and experienced a symptom-free recovery, but 1 died with severe cerebral edema and hemorrhage. Seven of the remaining 15 patients were initially treated with anticoagulation therapy for periods ranging from 2 days to 2 months (average 11 days). These 7 patients were considered to have failed anticoagulation therapy since they had worsening symptoms, and 5 of these had developed hemorrhage on subsequent CT or MR imaging scans. Five of the 7 then underwent thrombectomy with the administration of tPA. Of the remaining 2, 1 underwent thrombectomy alone without the administration of tPA, and the other was given 1 million units of urokinase instead of tPA. Three of these patients had a symptom-free recovery, but 2 had residual left-sided weakness, 1 patient had a minimal gait disturbance, and another patient developed a transverse sinus arteriovenous fistula 7 months after thrombolytic therapy. The remaining 8 patients did not receive anticoagulation therapy, and went straight to treatment with thrombectomy and administration of tPA. All of these presented with worsening clinical symptoms. Six had hemorrhage on their imaging studies, 1 had new edema on a subsequent CT scan, and 1 had edema along with the dural sinus thrombosis, but experienced worsening clinical symptoms consisting of headache and atypical dystonia. Five of these 8 patients experienced a symptom-free recovery, and 3 patients had mild residual weakness. Conclusion In patients with acute dural sinus thrombosis, an indication for thrombectomy or thrombolytic therapy may be the development of cerebral venous congestion which appears to include (1) worsening or severe clinical symptoms, and/or (2) CT or MR imaging findings including intracranial hemorrhage, a hematoma, or edema. It appears that anticoagulation therapy alone is not adequate in patients with acute dural sinus thrombosis when they develop cerebral venous congestion. This may be due to a lack of sufficient collateral flow. Those patients who went straight to thrombectomy because of worsening symptoms, or the imaging findings of cerebral vascular congestion, survived with either a symptom-free recovery or only mild residual neurologic deficit. The patient with evidence of cerebral venous congestion died while on anticoagulation therapy. Thus, the presence of cerebral venous congestion in patients with dural sinus thrombosis, even while on anticoagulation therapy, appears to be an indication for thrombectomy and infusion of thrombolytic agent through a balloon catheter to the site of thrombosis. Our experience suggests that this approach appears to improve the chance of survival, with either a symptom-free recovery or a recovery with only mild residual neurologic deficit.     

Technical Feasibility of Suction Thrombectomy Using a Large-Bore Aspiration System in the Portomesenteric Venous System

PurposeTo assess technical feasibility and safety of portal vein thrombectomy with suction thrombectomy using a large-bore thrombectomy device for portomesenteric venous thrombosis (PMVT).Materials and MethodsAfter receiving approval from institutional review board, patients undergoing PMVT treatment using a large-bore aspiration thrombectomy device (Inari FlowTriever or ClotTriever) between July 2019 and June 2021 were identified at 2 medical centers. Charts were reviewed for demographic information, imaging findings, and procedural details. PMVT was categorized using the Yerdel grading system. The thrombectomy procedure was performed via transjugular access through the existing or a new transjugular intrahepatic portosystemic shunt (TIPS) or transsplenic or transhepatic approach. Technical success was defined as successful clot reduction and restoration of portal venous flow at the conclusion of the procedure. Patient outcomes based on clinical presentation, adverse events, and thrombectomy-associated adverse events were recorded.ResultsTwenty patients, with a median age of 58 years (range, 23–72 years), underwent large-bore aspiration thrombectomy, which was technically successful in 19 of 20 (95%) patients. In 9 of 20 (45%) patients, 9 of 20 (45%) patients, and 2 of 20 (10%) patients, the 20-F, 16-F, and 24-F devices were used, respectively. Fourteen patients had a pre-existing TIPS, and 6 patients had a TIPS created. In 5 of 20 (25%) patients, overnight lysis was performed in conjunction with Inari thrombectomy. Thrombus resolution with restoration of flow was achieved in 19 of 20 (95%) cases. There were no thrombectomy-associated adverse events. The mean follow-up time was 70 days (±113) at which time primary patency of the portal venous system was present in 16 of 20 (80%) patients.ConclusionsLarge-bore aspiration portal vein thrombectomy is feasible for PMVT.     

Percutaneous vein graft reanastomosis with use of a covered stent to salvage a thrombosed hemodialysis graft

Technical success rates for percutaneous restoration of thrombosed arteriovenous grafts are high. However, in thrombosed grafts without restorable original outflow veins, percutaneous salvage is usually not possible. In this situation, patients are referred for bypass grafting or recreation of their vascular access sites. This report describes a patient in whom the original outflow vein at the venous anastomosis was completely obliterated and in whom vascular access was successfully salvaged by percutaneously reanastomosing the venous stump of the thrombosed graft with an adjacent patent vein. This procedure is technically feasible for the salvage of a thrombosed graft.     

Successful Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome in a Pediatric Patient

A 10-year-old boy presented to our clinic with left lower extremity swelling present for 1 year with deterioration of symptoms during the prior month. Laboratory investigation for deep vein thrombosis was negative. Venography and computed tomography scan of the pelvis showed compression of the left common iliac vein by the right common iliac artery. A diagnosis of iliac vein compression syndrome was made. After venography, endovascular treatment was planned. The stenosis did not respond to balloon dilatation and a 12 mm Wallstent was placed with successful outcome. The patient’s symptoms improved but did not resolve completely, probably due to a chronically occluded left superficial femoral vein that did not respond to endovascular recanalization. To the best of our knowledge, this is the first case of successful endovascular treatment of iliac vein compression syndrome with stent placement in a pediatric patient.