A 64-year-old male presented with right-sided weakness and CT head confirmed a haemorrhagic stroke in the left basal ganglia. On admission, he was recruited into the CLOTS trial, a multicenter randomised control trial assessing the use of intermittent pneumatic compression (IPC) in immobile stroke patients. A baseline ultrasound (US) Doppler scan of his lower extremities on day 2 post-stroke showed no thrombus and IPC was commenced.\nA follow-up US Doppler scan was conducted on day 10 post-stroke, as per trial protocol. Although the patient was asymptomatic, the US showed non-occlusive thrombi within the right common femoral and superficial femoral veins, with occlusive thrombi in the right popliteal and calf veins. There was no evidence of thrombus in the left leg. Anticoagulation and thrombolysis were contraindicated due to the recent haemorrhagic stroke, so a decision was made to insert a Günther Tulip® Vena Cava filter (Cook Medical, IA). The procedure was performed the following day, via an uncomplicated right femoral approach.\nA repeat US Doppler on day 30 post-stroke showed extension of the thrombus into the iliac veins bilaterally, and into the IVC. Long-term pharmacological anticoagulation was initiated, but the IVC filter was left in situ due to the extent of the thrombosis.\nOver the following year, the patient was lost to follow up. He re-presented 18 months later with features of PTS - including extensive swelling and oedema of his right leg extending up to his groin, pigmentation changes, venous eczema and active ulceration affecting his right lower calf and lateral thigh (). His left calf demonstrated pigmentation changes, but no swelling. He scored 20/30 points using the Revised Venous Clinical Severity Score. Examination further revealed prominent dilated tortuous superficial abdominal veins. The swelling of his right leg caused him excruciating pain, which compounded his residual mobility issues post-stroke, and rendered him wheelchair bound.
A 55-year-old male with left BCF, had VH with extensive edema of upper limb Upper limb DSA revealed left subclavian stenosis. BD with EVS was done and AVF was preserved, and limb edema disappeared in 72 h [].