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Restoring Venous Patency with the ClotTriever Following Deep Vein Thrombosis

Published:August 22, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.031

      Background

      Although randomized data remain inconclusive, invasive endovenous therapy is increasingly favored in patients with extensive iliocaval or iliofemoral deep vein thrombosis (DVT) to reduce the rates of postthrombotic syndrome. Previously, pharmacomechanical thrombectomy was the therapy of choice, but the Inari ClotTriever device is an appealing, purely mechanical, alternative. It may reduce bleeding risk, intensive care unit admission, and the need for multiple procedures when compared with traditional thrombolysis. We present a series of 18 patients treated with the ClotTriever for extensive iliocaval or iliofemoral DVT.

      Methods

      The Inari ClotTriever is a percutaneous mechanical thrombectomy system consisting of an expandable nitinol collection bag that is dragged along the vein wall, separating and capturing thrombus for collection into the retrieval sheath. We retrospectively reviewed all patients undergoing ClotTriever thrombectomy since the device became available at our quaternary referral center in June 2019. The review of these patients’ records was determined to be exempt by our institutional review board.

      Results

      Eighteen patients underwent ClotTriever thrombectomy between June 2019 and November 2021. Most patients (N = 16, 89%) presented within 2 weeks of symptom onset, and identifiable provoking factors were present in all patients. The most common provoking factor was anatomy, with May-Thurner syndrome present in 8 patients. All patients had restoration of unimpeded venous flow in the treated segments, although 3 had some residual nonflow limiting thrombus. There were no bleeding events or repeat venous procedures. The median postprocedure length of stay of 2 days. Postoperative venous imaging was performed in 15 patients and showed patency of the treated segment in 14 patients. Revised Clinical Venous Severity Scores were available in 14 patients during the course of follow-up. Of these, 9 patients' highest scores were 0, 2 patients' highest scores were 2, 2 patients’ highest scores were 4, and 1 patient had a high score of 8.

      Conclusions

      Venous flow was re-established in all 18 patients treated with the ClotTriever in this series, with no bleeding complications, and median postprocedure length of stay of 2 days. All patients with available follow-up, except 1, retained patency of the treated venous segments, and most had mild postthrombotic syndrome or none at all. These findings suggest that the ClotTriever is a safe and effective way to treat extensive iliocaval/femoral DVT.
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      References

        • Prandoni P.
        • Villalta S.
        • Bagatella P.
        • et al.
        The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients.
        Haematologica. 1997; 82: 423-428
        • Engelberger R.P.
        • Spirk D.
        • Willenberg T.
        • et al.
        Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis.
        Circ Cardiovasc Interv. 2015; 8: e002027
        • Vedantham S.
        • Goldhaber S.Z.
        • Julian J.A.
        • et al.
        Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis.
        N Engl J Med. 2017; 377: 2240-2252
        • Enden T.
        • Haig Y.
        • Klow N.E.
        • et al.
        Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial.
        Lancet. 2012; 379: 31-38
        • Kakkos S.K.
        • Gohel M.
        • Baekgaard N.
        • et al.
        Editor's choice - European society for vascular surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis.
        Eur J Vasc Endovasc Surg. 2021; 61: 9-82
        • Stevens S.M.
        • Woller S.C.
        • Baumann Kreuziger L.
        • et al.
        Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report.
        Chest. 2021; 160: 2247-2259
      1. Venous Thromboembolic Diseases: Diagnosis, Management and Thrombophilia Testing. National Institute for Health and Care Excellence: Guidelines, United Kingdom2020
        • Benarroch-Gampel J.
        • Pujari A.
        • Aizpuru M.
        • et al.
        Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 174-181
        • Shah N.G.
        • Wible B.C.
        • Paulisin J.A.
        • et al.
        Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems.
        J Vasc Surg Venous Lymphat Disord. 2021; 9: 615-620
        • Jolly M.A.
        • Shah D.
        • Huff C.M.
        • et al.
        Outcomes from a tertiary care center utilizing A catheter thrombectomy system for managing acute iliofemoral deep venous thrombosis.
        J Vasc Surg Venous Lymphat Disord. 2022; 10: 1044-1050
        • Maldonado T.S.
        • Dexter D.J.
        • Kado H.
        • et al.
        Outcomes from the ClotTriever Outcomes Registry show symptom duration may underestimate deep vein thrombus chronicity.
        J Vasc Surg Venous Lymphat Disord. 2022; https://doi.org/10.1016/j.jvsv.2022.04.015
        • Dexter D.J.
        • Kado H.
        • Schor J.
        • et al.
        Interim outcomes of mechanical thrombectomy for deep vein thrombosis from the All-Comer CLOUT Registry.
        J Vasc Surg Venous Lymphat Disord. 2022; 10: 832-840.e2
        • Vasquez M.A.
        • Rabe E.
        • McLafferty R.B.
        • et al.
        Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group.
        J Vasc Surg. 2010; 52: 1387-1396
        • Wang W.
        • Sun R.
        • Chen Y.
        • et al.
        Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis.
        J Vasc Surg Venous Lymphat Disord. 2018; 6: 788-800
        • Lichtenberg M.K.W.
        • Stahlhoff S.
        • Mlynczak K.
        • et al.
        Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis - a systematic review and meta-analysis.
        Vasa. 2021; 50: 59-67
        • Schulman S.
        • Lindmarker P.
        • Holmstrom M.
        • et al.
        Post-thrombotic syndrome, recurrence, and death 10 years after the first episode of venous thromboembolism treated with warfarin for 6 weeks or 6 months.
        J Thromb Haemost. 2006; 4: 734-742