The 69 y/o fisherman suffered from left leg chronic ulceration and stasis dermatitis for 1 year in Palau. He denied any cancer or coagulation disorders. He had hypertension and diabetes without well controlled. He visited local clinics and left deep vein thrombosis was suspected. He was prescribed with some coumadin and diuretics but his symptoms fluctuated. Therefore, he visited our hospital for the interventional therapy.
Compression vein echo showed partial thrombosis over left popliteal vein and superficial femoral vein.CT showed left iliac vein total occlusion and the pathophysiology was May-Thurner syndrome.
We approached from right IJV and left CFVbi-directionally. The CTO route was ambiguous and no clear stump over iliac bifurcation, so we started with knuckle wire antegradely. Due to extreme vessel tortuosity and poor back-up, the conventional knuckle could not succeed. We tried guide-extension and balloon anchor to stabilize the GC from both sides. Bi-direction wire overlapped each other after some efforts. R-CART was done and retro GWcrossed the lesion to IVC. After externalization, balloon angioplasty was performed with 8mm BC. 12mm VENVO stent was deployed. The VENOVO stent is designed for the iliofemoral veins with strong radial force, and crush resistance. The spent stuck in the halfway of deployment and the possible mechanism of was spur byMTS. Manual retraction was tried but the balloon could not cross destroyed strut. We tried another strut and did BADFORM technique. Another E-luminexx covered the fractured VENOVO stent successfully. rCART and wire cross.AVI Venovo stent stucked.AVI maunal retraction of stent.AVI
We experienced a rare complication of stent fracture when deploying a self-expandable stent in a very tortuous iliac vein. Our case demonstrated several possible bailout methods for this difficult situation.