In arterial system, in most cases it is sufficient to use PTA alone. In venous system, PTA must always be complemented by a stent placement. In this article we present, a thrombophilic female patient presenting with C6 (multiple active venous ulcers) who was managed by venous stenting from the suprarenal IVC to the EIV on both sides by double barrel configuration.
Patient and method:
Our patient is a 38-year old female with edema of both lower limbs and recurrent active venous ulcer (C6) of the right limb for 2-years with failure of 3-month compression therapy. She had previous attack of ilio-femoral DVT 15-years ago that was managed by anticoagulation. Her laboratory investigations showed thrombophilia in the form of hyper-homocysteinemia and elevated anti-cardiolipin antibodies. Direct MSCT-venogram showed occlusion of the IVC and iliac veins on both sides with engorged pelvic veins and unhealthy femro-popliteal veins. Endovascular treatment with venous stenting from the suprarenal IVC to the EIV on both sides by double barrel configuration. The patient is on dual antiplatelet, DOAC and folic acid 5mg/day.
Results:
At 1-month follow-up; direct MSCT-venogram showed patent stents, 1 of 3 of the venous ulcers healed. She had no residual edema of both legs. At 3-month follow-up; patent stents by DUS, 2 of the 3 venous ulcers healed and the last one is regressing. No postoperative complications were seen.
Conclusion:
Venous stenting still performing good even when there are no healthy landing zones.