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This 30 minutes interactive procedure concerns a 68 years old male presenting bilateral venous ulcers. He has a long  history of venous insufficiency with varicose veins surgery 44 years ago and bilateral Deep Vein Thrombosis 11 years ago.

He presents actually  bilateral iliac veins occlusion.

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Learning points

• Are chronic venous ulcers curable?
• How to approach bilateral vein occlusions.
• How to proceed to recanalize occluded iliac veins.
• How and where to stent residual vein stenosis.
• IVUS guided procedure to optimize evaluation and  stent deployment.
• How to perform bilateral ilio-femoral veins stenting in the same session.

Step-by-Step Procedure

• Double right internal jugular vein  access  with two 10Fx23cm  introducers.
• Crossing the Right and Left femoral veins occlusions using Hydrophilic wires and Triforce support catheter.
• IVUS run for landing zone assessment and sizing.
• Multilevel predilatation of the right and left systems.
• Simultaneous Kissing Stenting of the left and the right common iliac veins toward inferior vena cava respecting renal veins origin.
• Optimizing stent deployment and kissing balloon.
• Stenting of the  left  common femoral  and external iliac veins with Venovo self-expanding stent and balloon optimizing.
• Stenting of the right  common femoral  and  iliac veins  with overlapping : Venovo and Vici self-expanding stents.
• Stenting of the left common iliac vein with overlapping stent.
• Bilateral IVUS control.
• Final angiographic result.

Biobliography

• Deep Venous Thrombosis: An Interventionalist's Approach- Article
  Authors:J. Stephen Jenkins
  Publication:PMC4295740
   
• Demographic and clinical features do not affect the outcome of combined endovenous therapy to treat leg swelling. - Article
  Authors: Alsheekh A
  Publication: doi: 10.1177/1708538118760742.
   
• A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol. - Article
  Authors:van Vuuren TM, van Laanen JHH, de Geus M, Nelemans PJ, de Graaf R, Wittens CHA.
  Publication: doi: 10.1136/bmjopen-2017-017233.
   
• Patency rates and clinical outcomes in a cohort of 200 patients treated with a dedicated venous stent.- Article
  Authors:van Vuuren TMAJ, Doganci S, Wittens CHA.
  Publication:doi: 10.1016/j.jvsv.2017.09.013.

• The initial report on 1-year outcomes of the feasibility study of the VENITI VICI VENOUS STENT in symptomatic iliofemoral venous obstruction.- Article
  Authors:Razavi M, Marston W, Black S, Bentley D, Neglén P
  Publication: 2018 Mar;6(2):192-200. doi: 10.1016/j.jvsv.2017.10.014

• Interventional treatment of postthrombotic syndrome.- Article
  Authors:Jalaie H, Schleimer K, Barbati ME, Gombert A, Grommes J, de Wolf MA, de Graaf R, Wittens CH.
  Publication: 2016;21(Suppl 2):37-44. Epub 2016 Jul 12.