CASE REPORT 198 November 2012 Vascular Disease Management ® www.vasculardiseasemanagement.com Suraj Mammen, MBBS, MD 1 , Shyamkumar Nigudala Keshava, DNB, FRCR, FRANZCR 1 , Munawwar Ahmed, MD 1 , Edwin Stephen, MS 1 , Indrani Sen, MS 2 , Antony Devasia, MS, MCh, FRCS(Urol) 3 From the 1 Department of Radiology, 2 Department of Vascular Surgery, and 3 Department of Urology, Christian Medical College Vellore, Tamil Nadu, India. Endovascular Repair of Iatrogenic Inferior Vena Cava Stenosis in a Live Kidney Donor ABSTRACT: We report the endovascular treatment of a rare complication of iatrogenic inferior vena cava stenosis following a right live donor nephrectomy. This report highlights the clinical presentation, imaging, and management of such a case. VASCULAR DISEASE MANAGEMENT 2012:9(11):E198-E200 Key words: angioplasty, balloon angioplasty, inferior vena cava, interventional radiology A 58-year-old male live related do- nor with no comorbid factors and normal renal vasculature on pre- operative CT angiography was planned for a right nephrectomy. The right kid- ney was chosen as the left had a better relative function on isotope scan and also the right kidney had a relatively short renal vein, which would allow little room for cross clamp and anasto- mosis. Laparoscopic nephrectomy was not possible as there were dense adhe- sions, and an uneventful open donor nephrectomy was carried out by extra- perineal approach. One month postop- eratively he presented with progressive swelling of both legs. On examination the patient had typi- cal features of inferior vena cave (IVC) syndrome with pitting edema and ab- dominal wall veins. A Doppler study showed a dilated IVC with a nonvisual- ized infrahepatic segment above the re- nal vein drainage and adjacent multiple collaterals (Figure 1). There was severe segmental narrowing of the suprarenal– infrahepatic segment of IVC on contrast enhanced computed tomography (CT) scan (Figure 2). The CT done prior to nephrectomy had shown a patent IVC (Figure 3). A venogram was performed under local anesthesia through a right trans- femoral approach, which demonstrated a near total occlusion of the cranial IVC to the left renal vein with opacification of multiple paraspinal veins (Figure 4). The stenosis was crossed with a 0.035” hydro- philic wire (Terumo) and a 5F Van Schie seeking catheter (Cook). Balloon angio- plasty was performed using 8mm, 10mm, and 12mm balloons (Cook) serially. There was good restoration of the lumen. The pressure gradient across the ste- nosis was 49 mm Hg before angioplasty, which reduced to 24 mm Hg after the procedure. The patient showed signs of improvement. At 1 month, follow-up showed significant improvement of the lower limbs. DISCUSSION Obstruction of the IVC can be con- genital or acquired. The fully developed IVC is a complex structure derived from different segments of multiple paired longitudinal embryonic veins and the interconnections between them. 1,2 The complex development of IVC can cause webbing and strictures near the liver and diaphragm. Obstruction to the normal channel may result in the efficient col- lateral function like drainage through azygous and semi-azygous veins. Patients who have obstructed IVC may present with debilitating lower limb pain and swelling, back pain, weakness, and venous stasis ulceration. 3 Figure 1. Color Doppler shows a turbulent flow in the IVC with adjacent multiple col- laterals (A); high resistance flow noted in the IVC (B). A B For personal use only