•Based on the results of CT venography, planning decisions changed in 30% of cases

- puncture site and IVC filter placement    

- Catheter directed thrombolysis alone versus in combination with pharmacomechanical thrombolysis

- venous stenting

 Good preparation is half the battle and CT Venography is good preparation

•Helps to formulate the optimal treatment plan, approach, technique,  and most suitable treatment modality

•Also helps to counsel patient on expected outcome of treatment

Our experience demonstrating the value of CT Venography

•Case 1:27 year old female - 3/7 history of dyspnoea and right leg swelling

 Her CT venogram demonstrates extensive deep vein thrombosis of the entire left lower extremity from the ankle up to including the distal IVC, with associated May Thürner syndrome. Bilateral Pulmonary emboli were noted on CTPA.

Pre treatment (CTV based) plan

1.  IVC filter insertion

2.  Trellis® pharmaco-mechanical venous thrombectomy (PMT) of left lower extremity from the level of the popliteal vein up to the IVC

3.  Large-bore (16 mm) wall stent insertion IVC to the left external iliac vein

Treatment: venogram

Following 24 hours of catheter directed thrombolysis via a popliteal vein infusion catheter, completion venography demonstrated good inline flow.

3months post treatment CTV demonstrates complete patency of deep veins from the calf to IVC, with patency of inserted iliac vein stents

•Case 2: 78 year old male with a background history of prostate carcinoma presents with a 1 week history of left leg swelling

CT Venography demonstrates filling defect within a dilated left external iliac vein

 Filling defect in dilated left external iliac vein  and extensive surrounding subcutaneous oedema Images not included but extensive thrombus from calf veins to iliac veins was visualised on CT venography

Large left pelvic wall mass (later histologically proven metastatic deposit from known prostatic adenocarcinoma) with resultant extrinsic compression of the left common and external iliac vein.

Post treatment venogram post IVC filter insertion, left common iliac and external iliac vein stenting and pharmacomechanical thrombolysis from IVC to popliteal vein