Left Lower Extremity DVT

Physician

Michael Budler, MD
Vascular Interventional Radiologist
Bryan LGH Medical Center
Lincoln, NE

Background

A 61 year old male presented with left leg swelling and pain. The patient had a history of GI Bleed and ulcerative colitis. Because of this, the patient was not a candidate for systemic thrombolysis or IV Heparin anticoagulation therapy.

Procedure

The patient was brought to the interventional suite and placed in the prone position. Using a sterile technique and local anesthetic, a micropuncture needle was advanced into the popliteal vein. A venogram showed thombus present from the left femoral vein origin to the left popliteal vein. The Trellis®-8, an isolated pharmacomechanical infusion catheter, was placed so that the distal balloon was inflated in the left common femoral region. 

Approximately 5mg of t-PA was infused into the isolated segment. After an initial Trellis run time of 10 minutes, the thrombus was aspirated and the device was then moved inferiorly (towards the foot) and run with an additional 5mg of t-PA. A third run was performed infusing 5mg of t-PA followed by aspiration.

A follow up venogram revealed a mild to moderate chronic thrombus. An 8mm angioplasty balloon was used to dilate the narrowed segment in the left femoral vein.

Conclusion

The final venogram revealed no significant residual thrombus and good flow throughout the left femoral vein.  The patient tolerated the procedure well and there were no immediate complications.