LINC 2016 live case guide

Galway

• Tuesday, January 26th: 9:10 - 9:20, Room 2 - Main Arena 2

  Case 11 – GAL 01: Chronic left iliac reconstruction

  Center:

  Galway

  Case 11 – GAL 01: female, 41 years (N-W)

  Operators:

  • Ian Davidson,
  • Gerard O'Sullivan

  PRESENT STATE
  First DVT in 2009 – just post partum – see CT
  Waited 9 months, attempted endovascular reconstruction – failed.
  Has had 2 more children.
  Symptoms: weight gain, 50 m claudication up hill, heavy dead tired leg.
  
  RISK FACTORS
  Underlying May Thurner
  
  PROCEDURAL STEPS
  1. Prep
  - R IJV; left groin and thigh; right groin
  
  2. UltraSound (SIEMENS) guided access to left profunda and RIJV (COOK Micropuncture set)
  - 10F sheath (COOK) to neck; 5F sheath BRITE TIP (CORDIS) left PFV
  - 5000u IV Heparin
  - Triforce (COOK MEDICAL) to gain access to and attempt to cross left iliac venous occlusion
  
  3. Wires
  - Hydrophilic 0.035" wire (MERIT MEDICAL)/stiff
  hydrophilic 0.035" wire (MERIT MEDICAL)/
  Roadrunner 0.035" wire (COOK MEDICAL)
  - Asahi Astante 0.014" 30g tip CTO wire with back up 2.5 mm balloon
  - Possibly snare (AndraSnare, ANDRAMED) if needed/
  Lunderquist 0.035" wire 260 cm (COOK MEDICAL) once across
  
  4. Balloon predilatation
  - BARD Atlas 16/14 mm
  to minimum 16 atm x 30s each zone
  
  5. Stenting
  - BARD Venovo 16/14/12 from low IVC down
  to either low CFV or else into PFV
  
  6. Postdilatation
  - BARD Atlas again to same pressures and diameters
  - IVUS (VOLCANO / PHILIPS) to confirm stent apposition and identify any intra-luminal debris
  - Cone Beam CTV (SIEMENS) to confirm stent apposition
  
  7. Aftercare
  - Thigh high class 2 compression stockings (JOBST)
  - Pneumatic compression boots (COVIDIEN / MEDTRONIC) x 24h until US performed
  - Colour doppler US day 1 post op CTV direct at 6/52

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• Tuesday, January 26th: 11:15 - 11:30, Room 2 - Main Arena 2

  Case 15 – GAL 02 - Part 1

  Center:

  Galway

  Case 15 – GAL 02 - Part 1

  Operators:

  • Ian Davidson,
  • Gerard O'Sullivan

  New patient! Information will follow in due time. Thank you for your understanding.
• Tuesday, January 26th: 12:15 - 12:30, Room 2 - Main Arena 2

  Case 15 – GAL 02 - Part 2

  Center:

  Galway

  Case 15 – GAL 02 - Part 2

  Operators:

  • Ian Davidson,
  • Gerard O'Sullivan

  New patient! Information will follow in due time. Thank you for your understanding.
• Tuesday, January 26th: 13:30 - 15:00, Room 2 - Main Arena 2

  Case 17 – GAL 03: Failed varicose vein treatment; pelvic vein source

  Center:

  Galway

  Case 17 – GAL 03: female, 40 years (E-S)

  Operators:

  • Gerard O'Sullivan,
  • Ian Davidson

  CLINICAL DATA
  Three children, haemorrhoids and vulval varicosities
  during pregnancy
  Varicose veins left posterior thigh and calf
  treated by foam and RFA in June 2015
  At clinical follow-up 6 weeks satisfactory
  At 6 months ALL recurred
  
  IMAGING
  Mildly enlarged L ovarian vein
  Tight left common iliac vein compression on MRV
  CDUS – large varicose veins posterior thigh and
  upper calf - extend close to introitus
  
  PROCEDURAL STEPS
  1. GA
  - R I JV access
  - Selective catheterisation of L ovarian vein: both internal iliac veins;
  possibly right ovarian V
  - Coils (COOK MEDICAL) +/– EMBA medical "hourglass"
  - Foam (Sclerovein 3% diluted 3:1 with air)
  
  2. IVUS to examine is iliac vein compression syndrome real
  
  3. I f IVCS suggests it is real the predilate to 16 mm BARD Atlas
  
  4. Stenting if IVCS is real
  - COOK Zilver Vena 16 mm/VENITI Vici 16 mm/Wallstent 16 mm
  - OPTIMED Sinus Venous/Obliquus 16 mm
  
  5. Postdilate to 16 mm
  
  6. Foam sclerotherapy and RFA to thigh veins
  
  7. Transvaginal US to confirm ablationof all veins at 6/52

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