case_images: PMC4204234_01
case_images: 36-year-old woman with a history of autoimmune hepatitis and two prior orthotopic liver transplants who presented 5 years after her most recent transplant with a chief complaint of progressive bilateral lower extremity edema and weight gain was diagnosed with transplant-related, initially angioplasty-resistant IVC stenosis. Inferior vena cavagram reveals high-grade stenosis of hepatic level IVC (arrowhead), with 2-3 mm luminal caliber at this site.
case_images: JCIS-4-50-g002.jpg
case_images: PMC4204234_01_JCIS-4-50-g002.jpg
case_images: F1
case_images: She received intra-thrombus, low-dose (0.5 mg/h) tissue plasminogen activator (TPA) for 48 h, which resulted in complete clearance of the IVC clot, but revealed an underlying high-grade stenosis of the hepatic IVC at the level of the end-to-side transplant anastomosis just superior to the hepatic vein ostium [Figure 1].
case_images: 36-year-old woman with a history of autoimmune hepatitis and two prior orthotopic liver transplants who presented 5 years after her most recent transplant with a chief complaint of progressive bilateral lower extremity edema and weight gain was diagnosed with transplant-related, initially angioplasty-resistant IVC stenosis. Pre-treatment photograph shows marked lower extremity edema.
case_images: JCIS-4-50-g003.jpg
case_images: PMC4204234_01_JCIS-4-50-g003.jpg
case_images: F2
case_images: The patient's lower extremity edema thus persisted [Figure 2] despite systemic anticoagulation given for 2 months post-procedure.
case_images: 36-year-old woman with a history of autoimmune hepatitis and two prior orthotopic liver transplants who presented 5 years after her most recent transplant with a chief complaint of progressive bilateral lower extremity edema and weight gain was diagnosed with transplant-related, initially angioplasty-resistant IVC stenosis. Inferior vena cavagram performed following multiple venoplasty sessions reveals excellent response to therapy, with luminal diameter enlargement to 10-11 mm (arrowhead).
case_images: JCIS-4-50-g004.jpg
case_images: PMC4204234_01_JCIS-4-50-g004.jpg
case_images: F3
case_images: Upon completion of the sequential dilations, completion cavogram demonstrated an excellent response to treatment [Figure 3].
case_images: 36-year-old woman with a history of autoimmune hepatitis and two prior orthotopic liver transplants who presented 5 years after her most recent transplant with a chief complaint of progressive bilateral lower extremity edema and weight gain was diagnosed with transplant-related, initially angioplasty-resistant IVC stenosis. Post-treatment photograph demonstrates complete resolution of lower extremity edema.
case_images: JCIS-4-50-g005.jpg
case_images: PMC4204234_01_JCIS-4-50-g005.jpg
case_images: F4
case_images: Over the course of the next 3-4 weeks, the patient reported a fluid weight loss of approximately 90 pounds with concurrent reduction in her lower extremity edema [Figure 4].