# Venous Stenting, IVUS



## willnat2 (Sep 15, 2016)

Hi! I need help with a new procedure that we are doing in our cath lab.

PROCEDURES PERFORMED:
Ultrasound Guided Vascular Access
IVUS- Inferior Vena Cava
IVUS- Unilateral Lower extremity venous system- Left
Venous Stenting/PTA Left lower extremity
INDICATIONS:
Venous Right lower extremity VCS score:7
Venous Left lower extremity VCS score:7
Venous Right lower extremity VCS pain score:0
Venous Left lower extremity VCS pain score: 0
Venous Venous insurriciency CEAP classification Stage Right lower Extremity: C3-Swelling
Venous Venous insufficiency CEAP classification Stage Left lower Extremity; C3- Swelling
I87.2
INTRVASCULAR ULTRASOUND FINDINGS:
Inferior vena cava: inferior vena cava measurement is 259 mm
On the right side:
On the left side: the left common iliac vein references 163 mm2 with a compression area of 79 mm2 given a percent stenosis of 51%.
The left external iliac vein references 1 36 mm2 with a compression area of 33 mm2 given a 75% stenosis, left common femoral vein references 58 mm2 with a compression area of 28 mm2 and a 50% stenosis.
PROCEDURE NOTES:
The patient was brought to the cath lab in a resting and fasted state. Both of the patient's upper thigh area's were prepped and draped in the usual sterile fashion. Initially, local anesthesia was achieved with 1% lidocaine solution in the right upper thigh area. Under ultrasound guidance, the right femoral vein was enterd below the level of the deep femoral confluence and thena a J-tip guidewire was advanced and a 8-French sheath was advanced over the wire. Using similar technique, a 8 French sheath was placed in the proximal segment of the left femoral vein under ultrasound guidance with the entry point being just below the level of the deep femoral vein confluence. Venography was performed by simultaneous injuection of dye via both side ports and venogram of the lower segment of the inferior vena cava, both common iliac veins, both external iliac veins, both common femoral veins, also the proximal segment of both femoral veins were obtained. Then an 8Fr Volcano intravascular ultrasound imaging catheter was advanced over the J-tip guidewire to the lower segment of the inferior vena cava and then by slow manual pullback, intravascular ultrasound images of the lower segment of the inferior vena cava and then by slow manual pullback, intravascular ultrasound images of the lower segment of the inferior vena cava, the left common iliac vein, left external ilian vein, and left common femoral vein, and proximal segment of the left femoral vein were obtained. The images were reviewed, analyzed, and measurements were made. 
Once we determined there was high grade stenosis involving the left deep venous system we then predilated utilizing a 16 x 40 PTA balloon dilating the left common iliac vein, external iliac veinand common femoral vein. We then placed a 18 x 90 Wallstent starting in the IVC down into the distal left external iliac vein. We then postdilated that vein neear the IVC with a 16 x 40 balloon. We then placed a second 16 x 16 Wallstent into the left common femoral vein. IVAS ultrasound was then done which showed excellent opposition of the stent against the wall. The left common iliac vein post- stenting area is 152 mm2, left external iliac vein post-stenting area is 160 mm2 and the left common femoral vein post-stenting area is 121mm2.
The patient tolerated the procedure well and it was performed without any complications. The patient will return to th post cath recovery area for sheath pull and hemostasis via manual compression.
CONCLUSIONS:
Significant stenosis involving the deep left venous system of 50% or greater in the left common iliac vein external iliac vein and common femoral vein taken to less than 10% residual stenosis after PTA and stenting of the left common iliac vein, left external iliac vein and left common femoral vein.

76937 RT
76937 LT
75822
75827
37252
37253
37253
36011 RT
36011 LT
37238 LT
37239 LT

I would really appreciate some help. 

Thank you,
Leslie


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