Subacute Left Iliofemoral Deep Vein Thrombosis

Physician

Noah J. Jones, MD, MPH, FSCAI
Andrew T. Coletti, MD, FACC, FSCAI
Interventional Cardiology
Vascular Medicine and Endovascular Interventions
North Cascade Cardiology
Bellingham, Washington

Background

An 81 year old male presented with significant left lower leg swelling and pain. The patient had a history of pulmonary embolus after knee surgery and an IVC filter placement. The patient also had a history of coronary artery disease, with recent multi-vessel PCI and stenting. A duplex ultrasound revealed extensive left iliofemoral occlusive DVT.

Procedure

The patient was brought to the interventional suite and placed in the prone position. Using ultrasound guidance, bilateral popliteal access was gained using an 8Fr introducer sheath on the left side and a 5Fr sheath on the right. An 80cm x 30cm Trellis®-8, an isolated pharmacomechanical thrombolysis catheter, was placed in the left femoral vein and 6mg of t-PA were infused over one 15 minute run. The catheter was repositioned the left iliac and a total of 8mg of t-PA was infused over a 20-minute run period.

After two Trellis runs, adjunctive PTA was used (8mm x 60mm and 7mm x 40mm cutting balloon). Following PTA therapy, adjunctive rheolytic thrombectomy was performed. A 16mm x 60mm Wallstent® was then placed in the left iliac vein covering the ostium of the common iliac vein.

Conclusion

Completed resolution of venous claudication was achieved. Continued patency was observed 3 months post-procedure.