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Cardiology
Endovascular Venous Interventions
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
11 sections · 181 slides
Introduction
- Origins of catheter-based venous intervention
- Scope of modern venous intervention
- Venous beds treated by endovascular therapy
The inferior vena cava
- Inferior vena cava syndrome
- Congestive features of caval obstruction
- Stenotic disease of the inferior vena cava
- Angioplasty outcomes in Budd-Chiari syndrome
- Suprahepatic IVC obstruction
- Caval stenting after liver transplantation
- Caval stenting outcomes and complications
Acute inferior vena cava occlusion
- Causes of inferior vena cava occlusion
- Clinical spectrum and patient selection
- Timing of intervention in iliocaval thrombosis
- Catheter-directed thrombolysis technique
- Bleeding and embolic risk during caval lysis
- Thrombus burden and filter capture
- Pulmonary embolism rates with catheter therapy
- Prophylactic filter placement during intervention
- Ultrasound-assisted catheter-directed thrombolysis
- CT venogram of caval thrombosis below a filter
- Acute-on-chronic iliocaval occlusion
- Indications for percutaneous mechanical thrombectomy
- AngioJet rheolytic thrombectomy
- AngioVac vacuum thrombectomy
- AngioVac outcomes: the RAPID registry
- Appearance after mechanical thrombectomy
- Penumbra aspiration thrombectomy
- Inari mechanical thrombectomy and the CLOUT registry
- Rotational thrombectomy devices
- Rising use of adjunctive mechanical therapy
- Treating the lesion revealed by thrombectomy
- Outcomes of caval stenting after thrombectomy
- Patent cava after bilateral iliac vein stenting
Chronic caval occlusion
- Causes of chronic caval occlusion
- Caval occlusion at the level of a filter
- Rationale for delayed recanalisation
- Acute versus chronic phase caval occlusion
- Essentials of successful venous recanalisation
- Access and direction of traversal
- Blunt recanalisation technique
- False passages and venous tears
- Intravascular ultrasound during recanalisation
- Sharp recanalisation technique
- Risks of sharp recanalisation
- Stent configurations for iliocaval reconstruction
- Chronic caval occlusion treated through a filter
- Inflow and outflow as the governing principle
- Technical success and patency of iliocaval recanalisation
- Iliocaval reconstruction without filters
- Filter-related caval occlusion
- Does an occluded filter reduce stent patency
- Patency by reconstruction technique
- Clinical benefit after iliocaval reconstruction
- Dedicated venous stent technology
- Stent migration in the vena cava
Lower extremity veno-occlusive disease
- Iliofemoral segment as sole venous outflow
- Threshold for intervention in iliocaval disease
- Embolic risk and accepted indications
- When anticoagulation alone suffices
- The ATTRACT trial
- The CaVenT trial
- The CAVA trial
- The TORPEDO trial
- Catch-up phenomenon in post-thrombotic syndrome
- Pharmacomechanical versus catheter-directed thrombolysis
- Lytic catheter intervention and PTS risk reduction
- Thrombus clearance and post-thrombotic outcome
Chronic occlusive disease of the limb
- Iliofemoral versus femoropopliteal obstruction
- Chronic left common iliac vein occlusion after treatment
- Compensation in femoropopliteal occlusion
- Axial transformation of the profunda femoris vein
- Chronic total occlusion of the left iliac vein
- Recanalisation of femoropopliteal disease
- Evidence for femoropopliteal intervention
- Recanalised left iliac vein after angioplasty and stenting
- Limits of routine femoropopliteal recanalisation
- Mechanical thrombectomy without thrombolysis
- Access strategy in unilateral iliofemoral disease
- Crossing the occlusion in the limb
- Stent landing zones in the limb
- Right iliac vein occlusion on venography
- Judging technical success in low-flow segments
- Kissing iliac stent deployment into the cava
- Self-expanding stents in bilateral iliocaval veins
- Completion venogram after iliocaval reconstruction
- Dedicated venous stent trials
- Razavi meta-analysis of iliofemoral stenting
- Further meta-analyses of venous stenting
- Restenosis, occlusion and bleeding after stenting
- Razavi pooled data on iliac vein stenting
- Randomised evidence for stenting versus medical therapy
Non-thrombotic iliac vein lesions
- Definition of non-thrombotic iliac vein lesions
- From compression to fixed venous stenosis
- Clinical presentation of NIVL
- Prevalence of NIVL in advanced venous disease
- Indications for stenting a non-thrombotic lesion
- When not to stent a non-thrombotic lesion
- Intravascular ultrasound in NIVL assessment
- Non-thrombotic lesions versus post-thrombotic disease
- Overtreatment risk in iliac vein compression
- Limits of stenosis thresholds as predictors
- Venography underestimates iliac vein stenosis
- The VIDIO study
- Recommended IVUS thresholds and dynamic assessment
- Lesion preparation and stent length selection
- Stent migration in venous stenting
- Stent oversizing practice
- Optimal stent diameters by venous segment
- Surveillance after stenting for NIVL
- Antithrombotic therapy after NIVL stenting
Upper extremity venous disease
- Epidemiology of upper extremity venous disease
- Causes of central vein stenosis
- Subclavian stenosis in haemodialysis patients
- McCleery syndrome
- Dynamic obstruction of the left subclavian vein
- Selecting patients for upper limb intervention
- Balloon venoplasty of central vein stenosis
- Fibrotic lesions and stent use in the upper limb
- Lead- and catheter-related venous stenosis
- Surgery in venous thoracic outlet syndrome
- Treatment algorithm in venous thoracic outlet syndrome
- Treatment sequence in venous thoracic outlet syndrome
- Axillosubclavian venous thrombosis
- Paget-Schroetter syndrome
- Total occlusion of the right subclavian vein
- Subclavian stenting after rib resection
- Secondary axillosubclavian thrombosis
- Thrombolytic catheter in the axillosubclavian segment
- Procedural approach in axillosubclavian occlusion
- Venogram after catheter-directed thrombolysis
- Bilateral assessment in venous thoracic outlet syndrome
- Balloon angioplasty of the subclavian vein
- Subclavian venogram after angioplasty
- Crossing subclavian chronic total occlusion
The superior vena cava
- Causes of superior vena cava obstruction
- CT venogram of severe superior vena cava stenosis
- Endovascular therapy as first-line in SVC syndrome
- Access and imaging for SVC intervention
- Crossing and preparing the SVC lesion
- Superior vena cava venogram confirming stenosis
- Stent selection in the superior vena cava
- Y-configuration stenting for brachiocephalic involvement
- Relief of superior caval obstruction after stenting
- Outcomes of superior vena cava stenting
- Azizi meta-analysis of SVC intervention
- Complications of superior vena cava stenting
Summary
- Core principles of venous recanalisation
- Thresholds that guide intervention
- Patency figures worth carrying
- Complications to anticipate
- Where the evidence remains unsettled
- Conclusion
References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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