CASE 24 A 57-year-old female admitted to the hospital with gastrointestinal bleeding developed left leg swelling. Doppler ultrasound revealed deep venous thrombosis. The patient was referred to interventional radiology for inferior vena cava filter insertion. Figure 24-1 Filter insertion in caval duplication. (A) Inferior venacavogram shows small-caliber inferior vena cava and absent inflow from the left common iliac vein. (B) Selective venography of left caval segment. (C) Final plain radiograph after filter insertion shows filters in both caval segments. The right common femoral vein was punctured using the Seldinger technique, and the needle was exchanged for a pigtail catheter that was positioned in the inferior vena cava. Cavography revealed a relatively small-caliber infrarenal segment with prominent inflow from the left renal vein (Fig. 24-1A). Inflow from the left common iliac vein appeared absent. The left renal vein was selectively catheterized using an RC-1 catheter (Boston Scientific, Natick, Massachusetts), and a guidewire spontaneously entered a large vertical vessel. Venography revealed the left segment of a duplicated inferior vena cava (Fig. 24-1B). Duplicated inferior vena cava. Puncture needle or micropuncture kit
Clinical Presentation
Radiologic Studies
Venacavogram
Diagnosis
Treatment
Equipment
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