A 48-year old man has been affected by multiple sclerosis since 1991. In 2010, he received a diagnosis of chronic cerebrospinal venous insufficiency. The patient has undergone four procedures of bilateral internal jugular vein angioplasty and stenting for restenosis. This resulted in a thrombosis of the stents (Fig. 1). The complex anatomy ruled out a surgical treatment. The patient was discharged on anticoagulation therapy. 
Figure 1:
The echo-colour doppler and CT show the complications of an extreme endovascular treatment. (A) Occlusion of the right jugular vein, patency of the trunk of the brachiocephalic and subclavian vein and thrombosis of the left jugular vein and the brachiocephalic trunk with residual stenosis of 70%. (B) The extreme treatment and endovascular stenting (CT view). (C) Occlusion of the right jugular vein and stenosis of the left jugular vein with minimal residual lumen formation (CT view). (D) Stenosis of the left jugular vein with a thrombotic sleeve in the brachiocephalic trunk (CT view). CT: computer tomography.
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
