Aspiration thrombectomy for venous stent occlusion at the iliac vein
This a case of aspiration thrombectomy of an occluded venous stent after treatment of an iliac vein compression due to ovarian cancer. We used the Indigo thrombectomy catheter (Penumbra) to remove the clot and a Veniti stent (Boston Scientific) to optimize the final result. In this video, you will learn important steps of the procedure, tips and tricks for the use of the Indigo system as well as important features of both devices.
Nice case, Theo! What anticoagulation was this lady and what’s your OAC regiment fir such a patients? In such early occlusion (3/12) I would definitely use IVUS to make sure about the underlying pathology. 😉
Thank you Martin! The lady was under LMWH due to ovarian cancer. However, I do not believe that the reason for the occlusion was the anticoagulation. The possible reasons are (1) that the first stent did not cover adequately the compressed vein or (2) there was a progression of the tumour despite the radiation or (3) it was a paraneoplastic thrombosis. In any case, we are still using LMWH in patients with cancer-associated DVT. There is some evidence of dabigatran for such patients, but I think that we need more evidence especially after stenting of the iliac veins. What is your algorithm?
Finally, regarding IVUS, I cannot agree more with your comment. Fortunately, we have also IVUS now in our clinic. But the absence of clear evidence regarding the importance of IVUS does not allow reimbursement and several clinics cannot afford this type of examination. In my opinion and due to the increasing number of vein interventions, the societies of vascular surgery, interventional radiology and cardiology should focus on this issue.