Endovascular reconstruction of an interrupted inferior vena cava

INTRODUCTION

Inferior vena cava (IVC) interruption was established as a procedure to treat refractory venous thromboembolism (VTE) complicated by pulmonary embolism. Ilio-caval thrombosis and lower limb chronic venous insufficiency (CVI) are well known long-term complications of IVC interruption, where subsequent treatments may carry significant morbidity and mortality.

PRESENTATION OF CASE

We present here a case of chronic venous insufficiency resulting from IVC interruption with a vascular clip placed forty years previously. A novel approach utilising endovascular stents was used to reconstruct the iliocaval confluence and interrupted distal IVC without the need for laparotomy to remove the plicating clip. This procedure was associated with minimal morbidity and resulted with a quick resolution of the patient''s CVI symptoms.

DISCUSSION

Endovascular angioplasty and stenting is an alternative to open reconstruction of the interrupted inferior vena cava. We have demonstrated successful opening of a plication vascular clip using only endovascular utilities. Advantages include a shorter hospital stay, and reduced morbidity and mortality when compared to a re-do laparotomy.

CONCLUSION

Endovascular stents may be used safely and effectively to reconstruct the surgically interrupted inferior vena cava in the treatment of chronic venous insufficiency.