A 92-yr./old female with chronic, unilateral, iliofemoral DVT and IVC filter placement claims to have had a "shunt" placed at the same time of the filter in order "to prevent future DVTs". In 2000 she was hospitalized with a CVA. During the admission she developed the initial DVT. Unable to anticoagulant due to her admitting diagnosis, the filter was placed.
Recently she developed symptoms consistent with post-phlebitic-syndrome. I just performed a venous ultrasound and discovered an extensive old iliofemoral thrombus. Of interest I documented PW Doppler waveforms in the CFV, PFV, FV and Pop V that were consistent with flow in an artery supplying a low resistant vascular bed(sharp upstroke with significant, holodiasolic velocities). The contralateral deep vein PW Doppler were somewhat pulsatile but more consistent with CHF.
My question... is there or was there any procedure done for prevention of future DVTs that involved an arteriovenous shunt?
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