Medtronic Live Case: Deep Venous Stenting Technique for NIVL

Femoral Access and Confirming Outflow Obstruction

Stephen Black accessed the mid thigh femoral vein under ultrasound using a micropuncture kit, then advanced a nine French sheath and used IVUS to confirm outflow obstruction at the may-thurner crossing point, where contrast held up and drained preferentially through the internal iliac vein.

Sizing the Stent from Normal Vein Diameter

Black measured the minimum and maximum diameter of a normal external iliac vein segment, took the midpoint, and oversized by two millimeters, warning that sizing from the distended common iliac vein instead produces a massively oversized, poorly performing nitinol stent.

Pre-Dilation and Choosing Stent Length

After pre-dilating to break trabeculations and scar tissue, Black favored long stents of at least 90 millimeters, often 150, to reach a strong external iliac landing zone, since shorter stents carry clearer evidence of migration risk.

Post-Dilation, IVUS Confirmation, and Closure

Following deployment, Black post-dilated the stent to its nominal diameter to strengthen the nitinol, confirmed full expansion with IVUS before completion venography to reduce radiation and contrast use, and closed with a thigh length compression stocking.