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Initial Experience using VenaCore Catheter for Chronic DVT Patient
Oleksiy Gudz, Mohammed Moursi, Victoria Malak, Charles Shirley
University of Arkansas for Medical Sciences, LITTLE ROCK, AR
Background:Chronic deep venous thrombosis (cDVT) can result in Post-Thrombotic Syndrome (PTS), which has symptoms of swelling, ulcers, and venous claudication. Up to 50% of patients with acute DVT have a risk of PTS if not treated. We present a successful cDVT surgical treatment experience and our tips and tricks using the new VenaCore (Inari, Irvine CA) device. This device disrupts and dislodges adherent venous clots and captures them so one can mechanically remove them.
Methods:A 45-year-old male with a history of cutaneous T-cell lymphoma, chronic kidney disease, and pulmonary emboli on anticoagulation presented with complaints of penile and scrotal swelling, as well as severe right lower extremity (RLE) pain and swelling, C₄EₚADPₚ by CEAP classification. CT showed occlusive thrombus within the right common iliac vein extending to the right external iliac, common femoral vein, and superficial femoral vein, his lower limbs arteries were patent. Venous duplex ultrasound confirmed these findings. The patient proved to be a candidate for endovascular venous thrombectomy. The right popliteal vein was accessed using ultrasound guidance and a micropuncture set. A 5 French sheath was placed, and the patient was heparinized with 5000 IU bolus. Using a 5 Fr Glidecath and 0.035 Glidewire (Terumo, Southaven MS), the thrombotic lesion was crossed. Subsequent venogram revealed stenosis in the right common iliac vein extending down into the popliteal vein, suspicious for acute and chronic thrombus. We upsized to a 16 Fr sheath and with the combination of VenaCore and ClotTriever (Inary, Irvine CA) performed thrombus removal retrieving old white clots. Areas of stenosis in the iliac and femoral veins remained. Balloon angioplasty with the 8 x 80 mm Ultraverse balloon catheter (Bard, Tempe AZ) was performed in the right common iliac vein and femoral vein. We made several more passes with the VenaCore catheter with simultaneous contrast injection through a 4Fr sheath placed in the 16Fr sheath. We retrieved long segments of old, formed clots. Intravascular ultrasound visualized areas of stenoses and measured venous diameters. Focal vein defects with small adherent clots were stented with Zilver Vena (Cook, Bloomington IN). Completion venogram showed a patent iliofemoral venous system with brisker flow and minimal residual stenosis.
Results:The patient tolerated the procedure well with no complications, RLE edema decreased, and he was discharged on post-op day 3 due to his comorbidities and restarting anticoagulation. He was seen 1-month postop with improvement of symptoms and patent femoral and iliac veins.
Conclusions:VenaCore catheter offers new possibilities for chronic venous blood clot removal in patients with PTS. We recommend aggressive balloon dilatation before using VenaCore catheter with simultaneous contrast injection when capturing formed blood clots. Long-term studies are needed to evaluate patency rates, symptom relief and quality of life improvement, CEAP category change.
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