Acute Thrombolysis-Resistant Occlusive Left Femoral and Iliac Venous Thrombosis Treated with Mechanical Thrombectomy via the ClotTriever Device.

Background: Deep vein thrombosis (DVT) is frequently treated by anticoagulation, which helps to prevent new thrombus formation, but to restore venous flow, additional efforts might be needed. Thrombolytic agents can help clear acute thrombus, but increased bleeding risk is a concern; frequent contraindications are another. One lesser discussed potential limitation is thrombus age, which can affect efficiency of treatment.

Methods: A 62-year-old female patient with extensive DVT affecting the inferior vena cava (IVC) through the left femoral vein was initially treated with EKOS catheter directed thrombolysis (CDT) for 24 hr. Subsequent venogram revealed persistent, occlusive femoral and iliac thrombus. We decided on mechanical thrombectomy via the ClotTriever catheter (Inari Medical, Irvine, California), a nitinol coring element with an attached collection bag that can remove wall-adherent thrombus. We performed three passes with the device and removed large amounts of organized thrombus. Subsequent venography showed complete resolution of the occlusion. Finally, an underlying compression was treated via stenting.

Conclusions: ClotTriever was effective in removing subacute and chronic thrombus, as demonstrated in this case with persistent extensive thrombus after 24 h of CDT. The ClotTriever System adds a valuable option for vascular interventionalists to treat DVT.