30 year old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral deep venous thrombosis (DVT). Patient was started on anticoagulation. 5 days later, still having severe swelling and pain. Pharmacomechanical thrombolysis using TPA and the angiojet was performed with removal of the bulk of the thrombus. Stenting and venoplasty of the compression of the left common iliac vein was then performed. Patient had complete relief of symptoms nearly immediately and continues to do well 3 years later. No problems of post thrombotic syndrome.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Painful varicoceles interfering with high school athletics
Renal vein stent placed for Nutracker Syndrome was placed too far into the IVC and causing pain. Stent was partially removed.