Percutaneous Thrombectomy Using the ClotTriever Device for Acute Iliofemoral Deep Venous Thrombosis

Abstract

Iliofemoral deep venous thrombosis (DVT) is associated with significant short- and long-term morbidity. Early thrombus removal is postulated to prevent the development of post-thrombotic syndrome by restoring unobstructed deep venous flow. Pharmacomechanical thrombolysis may be prohibitive in select patients with significant bleeding risks. The novel percutaneous thrombectomy device (ClotTriever; Inari Medical, Irvine, Calif) can minimize or even alleviate the need of thrombolytics while restoring venous patency. Patients who underwent percutaneous venous thrombectomy using the ClotTriever device for iliofemoral DVT between 2019 and 2020 were identified. Baseline demographics, risk factors, presenting symptoms, and perioperative outcomes were recorded. Technical success was defined as complete thrombus resolution based on venography or intravascular ultrasound. Major bleeding was defined as the need for blood transfusion, surgical reintervention, or intracranial hemorrhage. Ten patients were identified during the study period. Mean age was 62.8 years (range, 42-79 years). There were seven men and three women. All patients had iliofemoral DVT and four patients had clot extension into the vena cava. Four patients had one or more underlying risks factors for venous thrombosis and two patients had contraindications to the use of thrombolytics. Eight patients presented with debilitating lower extremity venous congestion and two patients with phlegmasia cerulea dolens. Popliteal access was used for device insertion in 100% of patients. In four patients, catheter-directed thrombolysis was initially used but was found to be unsuccessful, thus necessitating the use of percutaneous thrombectomy. Intravascular ultrasound was used and concomitant venous stenting was used in three patients. Technical success, defined as complete clot resolution, was achieved in 100%. Immediate symptom resolution was also achieved in all 10 patients. Two patients required postintervention blood transfusions, one patient for a non-procedure-related retroperitoneal hematoma and the other for asymptomatic anemia. The ClotTriever venous thrombectomy system is effective at restoring caval and iliofemoral patency in the acute setting with or without the need for adjunctive catheter-directed thrombolysis. The theoretical benefits of this new technique include a shorter length of stay in the intensive care unit, avoidance of lytic therapy, and quicker recovery. The safety and effectiveness of these devices have yet to be defined. Comparative studies with current pharmacomechanical techniques are required.