Sharp recanalization using a subintimal reentry device, angioplasty, and stent placement for severely symptomatic iliofemoral deep venous thrombosis secondary to congenital aplasia of the inferior vena cava.

Iliofemoral deep venous thrombosis (DVT) secondary to congenital caval abnormalities is uncommon but should be suspected in younger patients presenting with bilateral DVT. Prior reports have described thrombolytic therapy and angioplasty for noncongenital caval occlusion and intraluminal recanalization for suspected congenital caval obstruction. A novel case is described of a young woman presenting with iliocaval DVT and phlegmasia, in which recanalization of presumed caval atresia or agenesis was accomplished using sharp recanalization with a subintimal reentry device, followed by thrombolysis, angioplasty, and stent placement to obtain caval patency and complete symptomatic relief.