65 year old male, T3a prostate cancer. Underwent robotic lymph node dissection for staging. Post operative lymphocele developed along the left external iliac vein. Percutaneous drainage decompressed the fluid collect and improved the leg swelling. Collection re-occurred and the leg swelling worsened with severe pain. Venography and intravascular ultrasound (IVUS) showed severe narrowing of the external iliac vein. Stenting and venoplasty of the external iliac vein was performed with complete resolution of the leg swelling and pain.
83 year old male, Type I Diabetes, end stage renal disease, living independently who was told he needed a below knee amputation.
87 year old with severe left leg claudication limiting ability to walk more than 100 feet
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.