DVT Case Study 1

IIliofemoral DVT

Background

A 68 year old female presented with phlegmasia of her left leg with extensive iliofemoral deep vein thrombosis (DVT) and an occluded vena cava filter. The patient’s foot was discolored and mottled with +2 swelling. The goals of venous thrombolysis are symptomatic relief, venous valvular preservation and reduction of pulmonary embolism.

Procedure

A Cragg-McNamara infusion catheter was placed in the inferior vena cava (IVC) and overnight lytic therapy was instituted. The next morning the patient was brought to the catheterization suite and placed in the prone position. A 5Fr introducer sheath was placed at the left popliteal. A venogram of the left leg revealed patency of the IVC and the vena caval filter, however, extensive thrombus was noted throughout.

The 5Fr sheath was exchanged for a 9Fr introducer sheath in to the left popliteal vein. Once the sheath was in place, the Trellis®-8 Peripheral Infusion System, an isolated pharmacomechanical infusion catheter, was used to lyse and aspirate the thrombus in the IVC, the left common and external iliac veins and the deep femoral venous system to the level of the popliteal vein.

Successful isolated pharmacomechanical thrombolysis was carried out and the completion venogram showed 100% patency of the left superficial femoral, iliofemoral and inferior vena caval systems. The patient was continued on Heparin therapy throughout the procedure. Duplex ultrasound was utilized at the end of the procedure to evaluate the posterior tibial vein at the ankle for potential access. This could not be visualized, however, as she has had chronic thrombus below the knee dating from 2002.

Conclusion

Following overnight thrombolytic therapy, the patient experienced recanalization of the IVC. The patient's previous extensive DVT in the iliofemoral region was aspirated with the Trellis-8 catheter. The patient experienced overnight symptomatic relief with reduction in swelling and pain.

Figure 1

Completely occluded Iliac and femoral vein

Figure 2

Chronic clot causing stenosis

Figure 3

100% clearance with brisk out flow