1Ahmed Elzein Mohamed,1Emma Wilton, 1Emma Wilton, 1Andrew Wigham
1Oxford University Hospitals
The role of mechanical thrombectomy technology is increasing in the management of occlusive deep vein thrombosis (DVT). This paper describes the initial experience of eleven cases within a tertiary UK centre in the use of the ClotTriever device for mechanical venous thrombectomy.
Material(s) and Method(s):
A prospective database of all cases of venous thrombectomy with the ClotTriever device performed over a nine-month period was documented between 15/04/21 to 12/01/22 at a single tertiary UK hospital. Demographics, initial presentation and immediate procedural outcomes were recorded. Symptom improvement was assessed alongside follow-up vascular doppler ultrasound study at 24 hours, 2 weeks, 3 months and 6 months post-procedure. Clot clearance was assessed during the procedure with visual estimation of a contrast venogram and intravascular ultrasound. Technical success was defined as successful clot evacuation without the need for post-intervention thrombolysis or the use of additional thrombectomy devices. Re-occlusion rates at six months and subsequent need for re-intervention of the treated segment were also measured.
Eleven individual patients were treated with the Inari ClotTriever device (7 Male, 4 Female). Median age of 53 years (range 18-70 years). General anaesthesia was used in 55% (6 patients) and local anaesthesia for 45% (5 patients) of cases. Popliteal vein of the affected side was used for access in all cases. Median number of passes with the ClotTriever device was 5 (range 4-12). Complete clot evacuation ranged between 80-90%. Average number of iliac/femoral vein stents inserted 1.55 (0-4). Primary assisted patency 100%, with a 3-month primary patency rate of 82% (two requiring re-intervention within 3 months). No requirement for thrombolytic therapy or ICU admission. The 30-day mortality was zero. Re-occlusion rate at six months was zero..
Initial experience suggests that the use of the ClotTriever device for mechanical venous thrombectomy in iliofemoral deep vein thrombosis is safe and effective. Follow up vascular ultrasound demonstrated good identification of the requirement for re-intervention. These cases contribute to the developing evidence base underlying venous thrombectomy and the increasing range of options for patients presenting with occlusive venous disease.