Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs.
This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound.
Seventy-three patients were included in the study. The follow-up of the patients’ clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months’ follow-up (p value Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency.

We report a 66-year-old male patient with severe right lower extremity swelling resulting from diffuse pelvic mass with compression on right external iliac vein. The patient had papillary urothelial carcinoma of bladder seven years ago and radical cystectomy and ureterostomy was performed. Recurrence of malignancy had occurred five years after the operation. The patient had also bilateral diffuse lung metastasis. The external iliac vein had severe stenosis and invasion of pelvic mass into the vein was evident on venography. Venoplasty of external iliac vein was performed throughout the stenosis. A venous stent of 80 mm length and 12 mm diameter was introduced over the guidewire and deployed in the external iliac vein. Dramatic clinical response was evident since postoperative day two. Swelling of right lower extremity was resolved dramatically on three-month and six-month follow-up visits. We believe that endovascular venous recanalization of iliac veins is feasible and safe in patients with unresectable and diffuse pelvic masses.

Context: 

May‑Thurner syndrome (MTS) is an anatomical defect where the right common iliac artery overrides and compresses the left iliofemoral vein. MTS causes deep vein thrombosis (DVT) but is often underdiagnosed. As anticoagulant management (warfarin) rarely achieves target INR, endovascular management is vital for MTS. Surgical and endovascular management of MTS has known to have similar good outcome. Endovascular management is generally facilitated using a venous stent. However, the unavailability of the venous stent in Indonesia made arterial stent be optimized during vein stenting procedure.

We aim to report our experience.

Settings and Design: 

Consecutive observational study within 26 months in a hospital in West Java including 6 MTS patients.

Diagnosis is established by the finding of proximal femoral DVT by ultrasonography further confirmed by computed tomography (CT) angiography. Endovascular management was done using arterial stent placement. After endovascular management, we reviewed the outcome on a follow‑up including stent fracture, in‑stent restenosis (ISR), and stent patency. These are also monitored by serial imaging by CT Angiography, with periods ranging from 1.5 to 10 months (mean: 4.08 months). Direct oral anticoagulants and antiplatelets are usually given along with compression stockings following the procedure.

Statistical Analysis Used: 

None.

No stent fracture, no ISR, and the stent remained patent after follow‑up. No patient had complications.

Apart from the difference in radial power compared to the venous stent, the arterial stent is feasible to use during MTS endovascular management with good postprocedural results. Prompt management is needed to prevent complication and chronic total occlusion. Comprehensive management should be ensured to optimize patients’ quality of life. We do hope that venous stent will be available in the future.

Children''s Medical Center, Tehran University of Medical SciencesChildren with diminished pulmonary blood flow (different forms of severe pulmonary stenosis or atresia) suffer from severe life-threatening cyanosis and need interventions to increase this flow. The classic way is a surgical modified BT shunt. However, this operation carries a 10% risk of death and a higher risk of morbidities like chylothorax, phrenic nerve palsy, and others .
A substitute to the surgery is ductal stenting. In many neonates, ductus arteriosus can be left open with the aid of prostaglandins and then by coronary or small peripheral stents to provide enough pulmonary blood flow. The procedure is less traumatic and equally successful. Based on the angle of ductus to the aorta and cardiac anatomy, it can be done via venous or arterial approach. The most fearing complication of the arterial approach is vascular injury which can be reduced almost to nil using small radial sheaths. Heart block is a frequent complication of the venous approach which may fail the procedure. Turtuosity of the ductus with acute angles may hamper its stenting. The whole length of the ductus should be stented; otherwise the unstented areas will contract and diminish the flow. Origin stenosis of the branch pulmonary arteries is a relative contraindication as ductal stenting may obliterate one or both branches.
In summary, ductal stenting is a reliable substitute to surgical shunt in many neonates with diminished pulmonary flow.

Regardless of the clinical setting, a good back-up represents one of the most important conditions to ensure guide wire and balloon advancement and stent delivery. As a “mother and child” system, the GuideLiner catheter (Vascular Solutions Inc., Minneapolis, MN, USA) provides an extension to the guide catheter with better coaxial alignment and stability. We report two didactic cases showing the usefulness of the GuideLiner device in everyday catheterization laboratory practice. The first case was a primary percutaneous coronary intervention (PCI) in a 71-year-old diabetic man admitted for inferior ST-elevation myocardial infarction, related to tight proximal stenosis in a dominant tortuous and calcified left circumflex. The second case was an elective PCI in a 76-year-old man admitted for stable angina (Canadian Cardiovascular Society [CCS] class III), related to focal intra-stent restenosis of a saphenous venous graft to the left anterior descending. In both cases, the GuideLiner catheter provided a good back-up insuring the success of PCI and drug-eluting stents implantation, with a good in-hospital outcome.

The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date.
To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction.
Patients and A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed.
Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean follow-up period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000).
TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.

Studies conducted by Zamboni et al. have suggested a new hypothesis that an abnormal drainage of venous blood due to stenosis or malformation of the internal jugular and/or azygous veins can be the cause of MS. They called this abnormality as “chronic cerebro-spinal venous insufficiency (CCSVI) could result in increased permeability of blood brain barrier, local iron deposition and secondary multifocal inflammation. In this presentation, we will discuss the more relevant scientific data related to this issue. Balloon angioplasty in a preliminary study by Zamboni improved symptoms in MS. High re-stenosing rates led authors to propose that the use of stents might be a better treatment than balloon angioplasty, although later they stated that stents should not be used. Balloon angioplasty and stenting have been proposed as treatment options for CCSVI in MS. Many patients who have had the surgical procedure report their improvements on social media websites such as structured patient databases and YouTube. Such stories are only anecdotal evidence of efficacy, and do not constitute a scientific proof of the efficacy of the treatment since for example, those who have had a positive result are more prone to post their cases than those who had little or no improvement, and the reported improvements in patients'' condition can be attributed to the placebo effect. Because there is a lack of research evidence to suggest that this is a safe or effective treatment for people with MS, we do not recommend that people undergo this procedure outside of a properly-regulated clinical trial.

Right internal jugular vein catheterization is a way to establish a temporary dialysis vascular access. Arterial injuries including inadvertent arterial cannulation and/or arteriovenous fistula formation are one of the most clinically important complications of hemodialysis catheter placement. Endovascular management of these conditions is a promising treatment option, especially for aged and co-morbid patients. This report represents a case of internal jugular vein-subclavian artery fistula formed by inadvertently misplaced double lumen tunneled cuffed central venous catheter that was treated successfully with covered stent graft placement.

Stenting in patent ductus arteriosus (PDA) and Rashkind septostomy in neonates with pulmonary atresia improves pulmonary and systemic venous bloodmixing and oxygen saturation. In the present study, a case of embolized stent and Rashkind septostomy that suffered hemolysis due to the stent was reported in a 2-day neonate with pulmonary atresia and single ventricle.

The patient was a 2-day-old boy neonate with a gestational age of 35 ± 2 weeks and a birth weight of 2800 grams. Neonates’ vital signs after birth were abnormal, and in the examination, cyanosis, tachypnea, grunting, and respiratory distress were observed. Auscultation had a systolic murmur at the left upper edge of the sternum. O2 saturation was about 70%, with a nasal oxygen intake of 3 L/min. Echocardiography confirmed the presence of pulmonary atresia and PDA. The initial treatment was done with prostaglandin E1, stenting in PDA, and a Rashkind septostomy. The neonate’s cardiac arrest occurred during stenting, and the neonate was resuscitated. The angiography examination indicated PDA stent embolization in the pulmonary artery, and due to the unsuccessful restoration of the stent, a decision was made to use a larger stent in the PDA. The neonate suffered from hemolysis on the second day and was discharged with conservative treatment within 2 weeks with a good general condition.

Keeping the PDA open with a proper stent and creating a Rashkind atrial septostomy improves the two-way mixing of pulmonary and systemic venous blood and oxygen saturation of neonates with pulmonary atresia and eliminates the need for surgery.

A 43-year-old man with liver cirrhosis received transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of recurrent variceal bleeding and F3 esophageal varices. During routine follow up liver ultrasound examination, six months after the implantation, TIPS occlusion was suspected and TIPS revision was performed. During the revision, moderate to severe stenosis at the hepatic venous segment of the tract and a total occlusion at the parenchymal segment of TIPS tract near the portal vein with biliary-TIPS fistula were identified with a clear visualization of the common bile duct. After the successful TIPS revision with the placement of an additional stent-graft, the biliary fistula and common bile duct were no more delineated. We herein report a rare case with an obvious visualization of biliary-TIPS fistula associated with obstruction of TIPS shunt on the tractogram and recanalization with an additional stent-graft.