Ces radiol. 2026, 80(2):114-120 | DOI: 10.55095/CesRadiol2026/022

Intravascular lithotripsy in the treatment of venous stent stenosis: a case and a review of current knowledgeCase report

Miloslav Roček¹, Tomáš Meliš¹, Petra Zimolová², Radek Pádr¹

¹ Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha

² Kardiologická klinika 2. LF UK a FN Motol, Praha Korespondenční adresa:

^V Úvalu 84, 150 06 Praha 5 e-mail: miloslav.rocek@lfmotol.cuni.cz miloslav.rocek@fnmotol.cz

Roček M, Meliš T, Zimolová P, Pádr R. Intra- vascular lithotripsy in the treatment of recurrent in-stent restenosis of the pelvic veins: case report and overview of the issue



Objective: To present a case of a patient with a severe form of venous thromboembolic disease and repeated in-stent restenosis of the iliofemoral area treated with intravascular lithotripsy and to propose a rational therapeutic procedure.

Methods: We describe the case of a patient with thrombophilia who underwent massive pulmonary embolism and bilateral phlegmasia cerulea dolens in 2013 with the need for systemic and local pharmacological and mechanical thrombolysis and implantation of venous stents. In the following years, repeated in-stent restenosis occurred, complicated in 2025 by acute rethrombosis in the field of significant calcifications. Recanalization using intravascular lithotripsy and subsequent re-PTA using a drug- coated balloon were performed.

Results: The procedure led to successful recanalization and restoration of flow without periprocedural complications. Follow-up duplex sonography demonstrated adequate flow. The patient was discharged hemodynamically stable.

Conclusion: Intravascular lithotripsy may represent an effective rescue method in

refractory in-stent restenosis of the iliofemoral area with a rigid component. A combination of lithotripsy and drug- coated balloon may be a rational strategy in high-risk patients.

Keywords: intravascular lithotripsy, venous stent, in-stent restenosis, chronic venous obstruction, interventional radiology.

Accepted: March 23, 2026; Published: July 1, 2026  Show citation