drsclafani wrote:mike, i would not be satisfied with those results.i think that there is incomplete opening of the valve as shows by the contrast in the cuffs.
i believe that five atmospheres will NOT be successful. Did you check for elastic recoil? did you repeat IVUs after venoplasty? I suspect that you will see that the valve leaflets are still not completely open.
i am still using high pressure. i havent yet done the calculation, but i am suspecting that pressure in range of 8-23 are necessary to eradicate elastic recoil
Hi Sal, not sure if you read the entire text or I didn't explain well enough.
What we are seeing post ballooning is the entrance of the EJ. In this case the EJ and IJ form a confluence before entering the SCV. If you look at the pre and post IVUS results the area of the IJ just above this confluence is 92 mm2. The post ballooning area at the level of the valve plane is 85 mm2. Very little residual stenosis. Any larger of a balloon would have lead to some dilation of the normal adjacent vein. At 14 mm the area of the balloon is 154 mm2. This is already significantly greater then the normal IJ area of 92 mm2. A 16 mm balloon with an area of 200mm would have been too large in my opinion and would have induced too much intimal damage and subsequent hyperplasia.
I have seen a rash of high grade restenosis and hyperplasia in patients that I have seen in follow up (both my patients and others).
This gets back to the rules of IR.....
It easy to come back and do more and its very hard to undo something you have done.
So the images.... with some better labeling
SCV venogram showing the confluence of EJ/IJ
Here is a composite image with venograms of the IJ and EJ superimposed with the IVUS at that level.
and here is the post ballooning image.
I don't think this is under treated.