Endovascular Treatment Of Acute Iliac Vein Stent Thrombosis Presenting As Phlegmasia Cerulean Dolens
Angelina Kim, MD, Nakia Sarad, DO, Rajeev Dayal, MD, Brian DeRubertis, MD, Jing Li, MD.
New York Presbyterian-Queens, Flushing, NY, USA.
DEMOGRAPHICS: 78 year-old Hispanic woman (case 1) and a 70 year-old Caucasian woman (case 2) with bilateral iliac vein stents placed in the remote past for venous insufficiency.
HISTORY: In case 1, the patient presented with severe pain and discoloration in the right lower extremity one week after initiation of therapeutic anticoagulation. She had an acute distal femoral DVT that extended into the right common iliac vein (CIV) with complete occlusion of her prior stent. In case 2, the patient had two weeks of worsening left lower extremity edema, and was found to have thrombosis and occlusion of the popliteal vein through the left CIV including the iliac stent. Both patients had signs concerning for phlegmasia cerulean dolens (PCD) including cyanosis and massive swelling. Both had recently been diagnosed with COVID, 6 weeks ago and on admission, respectively.
PLAN: Emergent intervention was undertaken for both patients with initiation of thrombolysis from ipsilateral popliteal vein access and placement of IVC filter for embolization protection. In case 1, repeat venogram the following day showed residual occlusion of the CIV portion of the right iliac stent with impingement at the caval confluence from the contralateral stent. This was treated with suction thrombectomy and balloon angioplasty which established excellent in line outflow (Figure 1). In case 2, repeat venogram showed residual thrombus in the femoral vein and iliac stent, which was also treated with suction thrombectomy and balloon angioplasty. Outflow was established into the IVC, and again the left iliac stent was noted to fully impinge the lumen of the caval confluence and the right iliac stent. Both patients did well postoperatively and were discharged on oral anticoagulation. IVC filter removal was performed several months later.
DISCUSSION: Iliac vein stenting has grown in its utilization for treatment of venous stasis. With increased prevalence in patient populations, it is important to acknowledge later complications that may arise. Our short case series demonstrates the dramatic presentation of acutely thrombosed iliac vein stents with PCD in the context of recent COVID infection necessitating immediate surgical intervention, which was successfully performed in an endovascular fashion.
Back to 2023 Abstracts