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Case Reports
. 2021 May 12;5(5):ytab107.
doi: 10.1093/ehjcr/ytab107. eCollection 2021 May.

A case report of successful intravascular shockwave lithotripsy and ad hoc directional venous atherectomy of extensive chronic femoral deep venous thrombosis

Yashwant Agrawal  1 , Pramod Ponna  1 , Dominika M Zoltowska  2 , Abdul R Halabi  1
Affiliations
Case Reports

A case report of successful intravascular shockwave lithotripsy and ad hoc directional venous atherectomy of extensive chronic femoral deep venous thrombosis

Yashwant Agrawal et al. Eur Heart J Case Rep. .

Abstract

Background: Conventional treatment for chronic deep venous thrombosis (DVT) is anticoagulation. However, limited interventional endovascular options exist for patients with non-healing venous ulcers secondary to chronic DVT.

Case summary: We present a case of 67-year-old man with severely symptomatic post-thrombotic syndrome (PTS) with persistent high-grade femoral DVT despite prior compressive therapy and chronic oral anticoagulation. It has been successfully treated with intravascular shockwave lithotripsy and ad hoc directional venous atherectomy facilitating subsequent mechanical thrombectomy and venoplasty. The procedure was without complication and resulted in significant clinical improvement.

Discussion: We believe our novel endovascular interventional approach represents a unique modality of intervention for patients with chronic DVT and PTS resistant to conventional venoplasty.

Keywords: Case report; Deep venous thrombosis; Doppler ultrasound; Intravascular ultrasound; Thrombus.

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Figures

Figure 1
Figure 1
Initial venogram (A) with extensive organized chronic thrombus with significant scarring on intravascular ultrasound imaging (B, C). Post-intervention venogram (D) with improved and patent lumen (E, F).
Figure 2
Figure 2
Venoplasty. (A) High pressure venoplasty with ‘dog-bone/waist’ appearance. (B) Cutting balloon venoplasty yielding the thrombus.
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See this image and copyright information in PMC

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References

    1. Enden T, Haig Y, Klow NE, Slagsvold C-E, Leiv Sandvik L, Ghanima W, CaVenT Study Group et al.Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012;379:31–38. - PubMed
    1. Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, The OPTIMEV-SFMV Investigators et al.Comparative study on the risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: Results from the OPTIMEV study. Thromb Haemost 2009;102:493–500. - PubMed
    1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016;149:315–352. - PubMed
    1. Nicolaides AN, Hussein MK, Szendro D, Christopoulos D, Vasdekis S, Clarke H.. The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg 1993;17:414–419. - PubMed
    1. Roumen-Klappe EM, den Heijer M, Jansen MC, van der Vleuten C, Thien T, Wollersheim H.. The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study. Thromb Haemost 2005;94:825–830. - PubMed

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