Single Session Mechanical Thrombectomy of Ileofemoral Deep Vein Thrombosis with ClotTriever– Exploring its Possibilities in an Outpatient Setting.

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Aaron W. Lyon

2nd Year medical student
University of Washington

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

QY

Qian Yu, MD (he/him/his)

Resident
University of Chicago
PT

Patrick Tran, MD

Resident Physician
University of Chicago
EU

Ethan Ungchusri, MD

Resident
University of Chicago
Anna Hu, BS (she/her/hers)

Medical Student
George Washington University School of Medicine and Health Sciences
MN

Monika Neale, n/a

Medical student
UChicago Med
JB

Jacob Benson, n/a

Medical Student
University of Washington
Osman Ahmed, MD

Associate Prof
University of Chicago

Disclosure(s):

Aaron W. Lyon: No financial relationships to disclose

Qian Yu, MD: No financial relationships to disclose

Anna Hu, BS: No financial relationships to disclose

Osman Ahmed, MD: Argon Medical: Advisory Committee or Review Panel Member (Ongoing); Asahi: Consultant (Ongoing); Bard Peripheral Vascular: Speaking and Teaching (Terminated, September 1, 2022); Boston Scientific: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Canon Medical Systems: Consultant (Ongoing), Contracted Research (Ongoing); Cook: Speaking and Teaching (Ongoing); Johnson & Johnson: Advisory Committee or Review Panel Member (Ongoing); Penumbra Inc.: Speaking and Teaching (Ongoing); Philips: Contracted Research (Terminated, October 1, 2022)

Purpose: To show the safety and effectiveness of mechanical thrombectomy (MT) using ClotTriever for iliofemoral DVT declot as an elective procedure performed on an outpatient basis with same-day or next-day 23 hour discharge.

Materials and Methods: A single-center retrospective review was performed of 5 elective iliofemoral DVTs treated by MT in an outpatient center using the ClotTriever system (Inari Medical; Irvine CA). The primary outcome assessed was the feasibility of treating patients in an outpatient setting with same- or next-day discharge. Safety outcomes assessed included serious adverse events within 30 days postoperatively. Efficacy outcomes were defined as ≥75% clot removal on post-thrombectomy venogram and stent patency using Marder scores.

Results: All 5 patients were successfully treated as outpatients. Of the patients treated by MT with ClotTreiever, 4 of 5 patients were discharged the same day and 1 patient was discharged on postoperative day 1. No patients required ICU admission. None of the five patients experienced serious adverse events within 30 days postoperatively. In all cases, the postoperative modified Marder’s score was 0.

Case 1&2: 47 year-old males with inferior vena caval filters (IVCF) associated bilateral iliofemoral DVT were treated with bilateral MT followed by double-barrel venous stents.

Case 3: 27 year old male with unprovoked DVT status post lysis and persistent narrowing at OSH was treated with serial venoplasty, MT from superior vena cava (SVC) to popliteal access, and double-barrel stent deployment.

Case 4: 73-year-old male with a history of prostate cancer was found to have an incidental DVT on surveillance magnetic resonance imaging (MRI). Pre-Opertative computed tomography (CT) showed a clot extending from the left iliac vein into the IVC. MT was performed from the infrarenal IVC to the left iliac vein. Repeat venogram demonstrated near complete thrombectomy.
Case 5: 22-year-old male with metastatic testicular seminoma presented with totally occluding DVT of the mid to distal inferior vena cava, right common iliac, and external iliac veins, and partial occlusive DVT of the right common femoral vein. MT was performed followed by venoplasty and double-barrel stent deployment.

Conclusion: Iliofemoral DVTs can be resolved using MT alone on an outpatient basis safely and effectively in carefully selected patients