Thrombectomy of a Complex Deep Vein Thrombosis: A Case Report

Abstract

A deep vein thrombosis (DVT) is a multifactorial condition characterized by a thrombus or blood clot developing in the deep veins of the upper or lower extremities. The presentation of DVT is characterized by unilateral peripheral edema and signs of inflammation in the affected extremity. The treatment of DVT is complex and case-dependent; however, most individuals are managed with oral anticoagulation therapy, while complex cases can be treated with advanced interventions. This report discusses a singular case of an atypical or complex DVT in a middle-aged woman with prior venous thromboembolic events undergoing a thrombectomy using an Inari FlowTriever system.

Keywords: deep vein thrombosis; deep vein thrombosis (dvt); endovascular thrombectomy; interventional radiology; ivc filter; oral anticoagulation; thrombus; wells dvt score.

Figure 1. Pre-thrombectomy venogram

(A) The initial venogram demonstrates significant thrombus in the iliac, femoral, and popliteal veins; (B) The pre-thrombectomy venogram shows extensive clot formation and collateral veins; (C) A large volume clot is present with collaterals in the venous system and an IVC filter already in place. IVC: inferior vena cava

Figure 2. Acute, subacute, and chronic thrombus were retrieved over an 80-minute period using the Inari FlowTriever system

Figure 3. Post-thrombectomy venogram

(A) A post-thrombectomy venogram showing brisk flow in the venous system and resolution of collaterals; (B) brisk venous flow in the superficial femoral vein; (C) brisk flow in the common femoral vein. No clot is seen post-treatment.