DrCumming wrote:New case.
53 yo female with relapsing remitting MS.
Venography showed severe bilateral IJ stenosis and azygous stenosis.
Azygous responded to venoplasty. Both IJ's initially dilated to 14mm. Tight waists in the balloon resolved at 15-18 ATM. Repeat venography showed severe recoil. Multiple repeat dilations, use of a cutting wire and upsizing to 16mm balloon done. Still little improvement in stenosis. Images from left IJ only shown. No clinical improvement at 1 month.
Patient does not want stents (and neither do I).
Thoughts? Options? What would others do differently?
Left IJ preballooning
Cutting wire (after several prolonged conventional balloonings)
Post venoplasty. Severe recoil.
if 14 mm allows elastic recoil, i would consider increasing balloon size. Routinely 14-18 mm in woman and 16-20 in men are endpoints before giving up. when angioplsty is successful, the pressure in the balloon drops precipitiously, the waist disappears and an audible pop is heard.
i have found that you can stretch but not disrupt the valve annulus at 14 mm so that the waist on the balloon appears to disappear. but when the rest of the vein continues to distend with a larger balloon, the stenosis waist "reappears" before it is disrupted.
i would give a try of a larger balloon.