Fig. 5

18 y/o M with chronic right lower extremity swelling and DVT presents for planning venogram after MRI demonstrated IVC agenesis from the level of the external iliac to the suprarenal IVC. a Initial venogram from the right groin shows numerous diminutive collateral vessels (dotted arrow). A wire was able to be passed from the left groin through collateral vessels (dashed arrow) to the suprarenal IVC (solid arrow). b Wires and catheters were eventually able to be passed through retroperitoneal collaterals until the bilateral accesses reached the suprarenal IVC (right groin access marked by dotted arrow, left groin access marked by dashed arrow, IVC solid arrow). c IVC reconstruction with stent complex placed from bilateral groins to the suprarenal IVC. d Final venogram through stent complex showed excellent outflow with no intrastent stenosis or delay in transit of contrast. e Follow up venogram at POD 45, demonstrated continued excellent outflow with no intrastent stenosis or occlusion. Patient’s symptoms of right lower extremity swelling was completely resolved. f Follow up venogram 5 months following stent placement, patient had begun to have difficulty with anticoagulation compliance and exhibited symptoms of leg swelling. Unable to pass a wire or catheter beyond the area marked with the solid arrow. g Accompanying venogram depicting complete occlusion of the right stent complex with chronic thrombus and numerous collateral vessels draining the right lower extremity (Note, patient is positioned prone). On IVUS, there was kinking of the stent complex near the femoral head which likely was at least partially contributing to the stent complex failure