Iliofemoral Deep Vein Thrombosis (DVT) with Vena Caval Filter Insertion

Physician

Kenneth Kollmeyer, M.D.
Vascular Surgery
Methodist Dallas Medical Center
Dallas, TX

Background

A 49 year old female presented with pain and swelling in her right lower extremity. The patient was brought to the endovascular suite and placed in a supine position. Using sterile technique, under local and mild sedation, the left femoral vein was accessed with a micropuncture set using a 0.018" access wire. The micropuncture wire was then exchanged for a 0.035" guidewire and an 8Fr introducer sheath was exchanged for the micropuncture dilator. Under flouroscopic guidance, a retrievable IVC filter was passed over the 0.035" wire, through the femoral access site, and then deployed in the IVC.

A venogram was performed and significant thrombus was seen extending from the common iliac vein to the distal femoral vein.

Procedure

The Trellis®-8, an isolated pharmacomechanical thrombolysis system was advanced over the 0.035" guidewire and the distal balloon was placed in the common iliac vein. The proximal balloon was then inflated at the level of the groin. The balloons isolated the proximal segment of the thrombus and allowed for isolated infusion of lytic through the Trellis-8 infusion port.

Pharmacomechanical thrombectomy in conjunction with focal concentrated lysis was performed by infusing 10mg of t-PA over the course of 13 minutes. After aspiration of the thrombus, the Trellis-8 device was repositioned to treat the remaining thrombus in the SFV. Another 10mg of t-PA was infused into the isolated treatment area, treated with the Trellis-8, and then aspirated after a 10-minute run.

A follow-up venogram showed several narrowed areas of stenosis. A 12mm angioplasty balloon was used to dilate the areas of stenosis within each segment.

Conclusion

The DVT extending from the right common iliac vein to the distal femoral vein was resolved. Improved flow was noted and no significant narrowing or thrombus was seen. The patient tolerated the procedure well with no noted complications.