22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT). Initial attempt at catheter directed thrombolysis without iliac vein stenting resulted in re-thrombosis. The patient had severe restriction in activity due to venous claudication and he wanted to see if anything could be done. He underwent stenting and venoplasty of the left common and external iliac veins. There was marked improvement in leg swelling and leg pain. However, the changes from the original DVT in the femoral and popliteal veins have left him with persistent swelling and discomfort.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
The tip of a hydrophilic wire was fractured and subsequently retrieved during the crossing of a distal anterior tibial artery near occlusion
71 year old female with a non healing ulcer on the left foot.