Inferior Vena Cava Reconstruction in Symptomatic Patients Using Palmaz Stents: A Retrospective Single-Center Experience.

BACKGROUND: The use of stents for treating central venous occlusion is well described. Limited evidence exists related to Palmaz balloon-expandable stent use in inferior vena cava (IVC) reconstruction. We analyzed patency and complication rates after IVC reconstruction using Palmaz stents. METHODS: From 2002 to 2019, 37 patients (mean age: 51 year) underwent IVC reconstruction with 68 Palmaz stents. Indications were symptomatic chronic venous obstruction in the infrarenal (n = 25) and intrahepatic (n = 12) IVC. Demographic, operative, and imaging data were evaluated. Clinical data, abdominal CT, and/or duplex ultrasound were used to determine patency at follow-up. RESULTS: Restoration of caval patency was achieved in all patients, with complications in 2/37 (5.4%) patients (thrombus formation within the stent; stent embolization eight days after placement). Follow-up data were available for 27 patients. Primary patency was maintained through last follow-up in 19/27 (70%) patients (mean: 1.1 year), with successful stent redilation performed in 6 patients. Mean duration of primary-assisted patency (n = 5) was 1.2 year. Late lumen loss was (n = 13) was 40% during a mean time to follow-up of 2.0 years. Primary patency in patients with occlusion secondary to malignancy was 109 day (range: 1 day-1.0 year), whereas primary patency in patients with occlusion from other etiologies was 1.1 year (range: 2 day-5.9 year). The Kaplan-Meier analysis demonstrated primary and primary-assisted patency of 66% and 84%, respectively, at 24 and 48 months. CONCLUSIONS: Palmaz balloon-expandable stents for IVC reconstruction is feasible and effective for symptomatic IVC occlusion. Risk of stent migration was low.

Intravascular ultrasound is a key diagnostic tool in subclavian vein varicosity.

Varicose veins of the neck are far less common than lower extremity varicosities. Often, neck varicosities can be a sign of a more central venous obstruction. Here, we describe a patient with no risk factors for central venous obstruction who presented with a recurrent left subclavian vein (LSV) varicosity causing significant pain and discomfort that was recalcitrant to repeated phlebectomy. Venography revealed a dilated LSV with no significant venographic stenosis in the LSV or brachiocephalic vein. Intravascular ultrasound subsequently revealed a culprit hypertrophied valve that was successfully treated with valvuloplasty, resulting in durable resolution of the patient's symptoms, suggesting that intravascular ultrasound was essential in the diagnosis and treatment of this hypertrophied valve.

Effect of Substituting 50% Isovue for Sterile Water as the Delivery Medium for SIR-Spheres: Improved Dose Delivery and Decreased Incidence of Stasis.

PURPOSE: The objective of this study was to evaluate the effect of substituting 50% Isovue (Bracco Diagnostics Inc, Monroe Township, NJ) for sterile water on the delivery of Y resin microspheres (SIR-Spheres [Sirtex Medical Limited, Sydney, Australia]). MATERIALS AND METHODS: The authors retrospectively reviewed all SIR-Spheres radioembolizations at the authors' institution from January 1, 2011, to February 10, 2014. From January 1, 2011, to April 30, 2013, all users performed SIR-Spheres radioembolization per the manufacturer's original instructions using sterile water in the B and D lines and intermittently checking the progress of the embolization by injecting contrast via the B line. Beginning May 1, 2013, a modified technique using Isovue diluted 50% with saline in place of sterile water in both the B and D lines of the infusion set. The authors compared the prepared versus administered activity of Y SIR-Spheres, fluoroscopy time, administration time, and frequency of radioembolizations terminated for stasis when using water versus dilute contrast in the B and D lines. RESULTS: One hundred seventy-five radioembolizations were performed, 132 (75%) with water as the delivery medium and 43 (25%) with 50% contrast as delivery medium. The mean percentage of the Y activity administered was 98% with contrast versus 87% with water (P < 0.01). More than 95% of cases using contrast resulted in 90% or more delivery of the prepared Y activity versus 59% of cases with water (P < 0.01). For cases using water, 17% were terminated for stasis, whereas 2% (1 case) using contrast was terminated for stasis. The mean Y administration time was 7 minutes with contrast versus 22 minutes with water (P = 0.015). Excluding the 37 cases involving coil embolization, the mean fluoroscopy time was 8.3 minutes with contrast versus 11.5 minutes with water (P < 0.05). No complications occurred with the contrast method; however, there were 4 complications with water, including 1 nontarget gastric ulceration. CONCLUSIONS: Using dilute contrast as the delivery medium for SIR-Spheres resulted in a significantly greater percentage of the prepared activity administered to the patient with substantially shorter administration time. Termination for stasis occurred less often with dilute contrast. No complications were observed when using dilute contrast, which allowed continuous real-time monitoring of the Y microsphere administration.