Improvement in Recurrent Ascites From Multilevel Venous Obstruction With Transcatheter Caval and Iliac Vein Recanalization.

Authors

Ali Ardehali, Tushar Acharya, Deepak Acharya, Michael Seckeler

Published in

JACC. Case reports. Pages 110035. Aug 27, 2026. Epub Aug 27, 2026.

Abstract

Ascites commonly results from portal hypertension, malignancy, or cardiac disease. Systemic venous obstruction is an uncommon mechanism.
A 40-year-old woman with 2 prior kidney transplants, remote venous thromboembolism, and small bowel adenocarcinoma presented with recurrent ascites. Imaging revealed chronic superior vena cava (SVC) occlusion with collateralization to the inferior vena cava (IVC), IVC stenosis, and left iliac vein stenosis. Hemodynamics showed elevated SVC pressure, gradient from the left femoral vein to the IVC, and normal right atrial pressure. She underwent staged endovascular recanalization and stenting of the SVC, IVC, and left iliac vein, with repeated interventions for restenosis.
Multilevel systemic venous obstruction can produce clinically significant ascites through venous hypertension. Symptom relief is possible, but may require technically complex recanalization and repeat interventions.
Systemic venous obstruction should be considered in unexplained refractory ascites. Endovascular therapy can be effective, but often necessitates repeat procedures.

PMID:
42663344
Bibliographic data and abstract were imported from PubMed on 28 Aug 2026.

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