Zurich

• Tuesday, June 7th: 10:00 - 10:27, Main Arena 2

  Recurrent varicosis right leg and vulva varicosis due to pelvic congestion syndrome right ovarian vein

  Center:

  Zurich

  Case 17 – Zurich 01: Female, 33 years (M-D)

  Operators:

  • Nils Kucher,
  • Erik Holy

  CLINICAL DATA
  – Chronic venous insufficiency with recurrent symptomatic leg and vulva varicosis
  – History of embolization therapy of ovarian veins and right internal iliac vein
  – History of crossectomy and stripping of right great saphenous vein
  – History of foam sclerotherapy varicosities right leg
  
  RISK FACTORS
  – Duplex: nutcracker anatomy (image 2), no May Thurner anatomy,
  – right ovarian vein dilated with reflux
  – MRV: nutcracker, no May Thurner, both ovarian veins dilated and recanalized (image 1)
  – PCS Score (Kucher): 5 point
  
  PROCEDURAL STEPS
  1. Access right IJ ultrasound guided 5F
  
  2. Use 5F vertebral catheter or multipurpose catheter for selective venography of left renal vein and ovarian veins
  
  3. Valsalva venograms to both ovarian veins
  
  4. Catheter-directed sclerotheraphy to parauterine veins during Valsalva (Aethoxysclerol 3%)
  
  5. Coil embolization right ovarian vein and possibly left ovarian vein if reflux is present (Interlock, BOSTON SCIENTIFIC) in Sandwich-technique

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• Tuesday, June 7th: 11:16 - 11:36, Main Arena 2

  Pelvic congestion syndrome with nutcracker anatomy and left ovarian vein reflux in a nulliparous adolescent

  Center:

  Zurich

  Case 18 – Zurich 02: Female, 17 years (A-Y-E)

  Operators:

  • Nils Kucher,
  • Erik Holy

  CLINICAL DATA
  – Lower abdominal pain, aggravated by menstruation and upright position
  – Suspected endometriosis not confirmed, hormon treatment without improvement
  – No hematuria, no flank pain, no venous claudication
  – Pollakisuria
  – PCS score (Kucher): 5 points
  
  RISK FACTORS
  – Duplex: mild May Thurner anatomy, no reflux to left internal iliac vein,
  nutcracker anatomy with dilated left ovarian vein with reflux (image 1)
  – MRV: nutcracker anatomy with dilated left ovarian vein (8mm)
  
  PROCEDURAL STEPS
  1. Venous access to right IJ ultrasound guided 6F
  
  2. Selective venography with and without Valsalva of left renal vein
  
  3. If no left renal flow into IVC is visible, may consider transient balloon occlusion of left ovarian vein with simultaneous selective venography of left renal vein (requires second venous access)
  
  4. Foam sclerotheraphy (aethoxysclerol 3%) to parauterine veins
  
  5. Coil embolization left renal vein (Interlock BOSTON SCIENTIFIC) in Sandwich technique

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• Tuesday, June 7th: 13:30 - 13:50, Main Arena 2

  Persistent severe nutcracker syndrome post surgical transposition of the left renal vein and ligation of left ovarian vein

  Center:

  Zurich

  Case 19 – Zurich 03: Female, 21 years (A-B)

  Operators:

  • Nils Kucher,
  • Erik Holy

  CLINICAL DATA
  – Left flank pain accompanied with hematuria
  – History of non-thrombotic May Thurner Syndrome treated with Beyond stent with improvement of lower abdominal pain and leg claudication 10/2021
  – History of transposition of the left renal vein and ovarian vein ligation 12/2021
  – History of ballon angioplasty of left renal vein with no imrpovement of nutcracker syndrome 05/2022
  
  RISK FACTORS
  – Duplex: severe nutcracker with no flow in left renal vein (image 1)
  – MRV: severe nutcracker with recanalized left ovarian vein (image 2)
  – Venography: severe nutcracker with recanalized left ovarian vein (image 3)
  
  PROCEDURAL STEPS
  1. Venous access ultrasound guided puncture 10F right CFV
  
  2. Selective venography left renal vein using Cobra 5 F catheter. May use IVUS
  
  3. Left renal vein stenting (Arbre Stent, MEDTRONIC) or Wallstent (BOSTON SCIENTIFIC) or Epic Stent (BOSTON SCIENTIFIC)
  
  4. Postdilatation to 12 mm (Mustang, BOSTON SCIENTIFIC). May use IVUS to rule out stent compression

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• Tuesday, June 7th: 14:40 - 15:00, Main Arena 2

  Pelvic congestion snydrome due to non-thrombotic May Thurner anatomy

  Center:

  Zurich

  Case 20 – Zurich 04: Female, 18 years (A-K-P)

  Operators:

  • Nils Kucher,
  • Erik Holy

  CLINICAL DATA
  – Lower abdominal pain with aggravation during exercise and upright position
  – Pain radiation to left groin and venous claudication during exercise left leg
  – Pollakisuria
  
  RISK FACTORS
  – Known endometriosis post laparoscopic removal 6/2020 with no improvement of symptoms
  – Treadmill test with 12% inclination, 3,2 km/h: lower abdominal pain after 70 meter, pain left groin and left leg after 150 meter. Venous claudication persists after termination of exercise.
  – Duplex: No nutcracker but May Thurner anatomy (image 1), spontaneous permanent retrograde flow in left internal iliac vein
  – MRV: May Thurner anatomy
  
  PROCEDURAL STEPS
  1. Venous access ultrasound guided 10 F left CFV
  
  2. Venography left common iliac vein
  
  3. IVUS May Thurner
  
  4. Sinus obliquus stent into May Thurner lesion (OPTIMED)
  
  5. IVUS

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• Wednesday, June 8th: 13:30 - 13:55, Main Arena 1

  Endovascular Treatment of chronic superficial femory artery stent occlusion

  Center:

  Zurich

  Case 25 – Zurich 05: Male, 72 years (K-G)

  Operators:

  • Nils Kucher,
  • Erik Holy

  CLINICAL DATA
  – Symptomatic PAD of the left lower leg since 01/2022, currently worsening and Fontaine stage IIb (100 m)
  
  RISK FACTORS
  – CVRF: former smoker, Dyslipidemia
  – Left SFA: PTA/Stenting chronic occlusion 2018, PTA in 2019 Stent restenosis,
  – PTA/DEB/Stenting 2021 In-Stent occlusion (currently on DAPT)
  – TEA and resection of a right CFA anuerysm 2018
  – Duplex 05/2022 (Figure 1 and 2): occluded Stent, reconstitution of distal popliteal artery via collateral vessels
  
  PROCEDURAL STEPS
  1. Antegrade access left CFA (6 F)
  
  2. Diagnostic angiography
  
  3. Catheter supported recanalisation of SFA occlusion
  
  4. Rotarex Atherectomy (6F or 8F) (BD)
  
  5. PTA +/- stenting of SFA/popliteal artery

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