Effective single-session percutaneous nonpharmacologic mechanical thrombectomy for phlegmasia cerulea dolens

Abstract Background COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. Case presentation A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. Conclusions This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.

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Abstract No. 128 Rapid single-session mechanical thrombectomy of lower extremity deep venous thrombosis using the ClotTriever system: a single-institution experience

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.03.134 ◽

2021 ◽

Vol 32 (5) ◽

pp. S57

Author(s):

V. Wadhwa ◽

A. Malhotra ◽

A. Kesselman

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Mechanical Thrombectomy ◽

Single Session ◽

Single Institution ◽

System A

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Management of Phlegmasia Cerulea Dolens Caused by a Giant Leiomyoma

10.21203/rs.3.rs-892622/v1 ◽

2021 ◽

Author(s):

Elisabeth Ekkel ◽

Tara Chandran ◽

Ryan Qasawa ◽

Michael Trpkovski ◽

Sachinder Hans

Keyword(s):

Uterine Leiomyoma ◽

Inferior Vena ◽

Mechanical Thrombectomy ◽

Vena Cava ◽

Iliac Vein ◽

Young Female ◽

Common Iliac Vein ◽

Venous Obstruction ◽

Recurrent Thrombosis ◽

Phlegmasia Cerulea Dolens

Abstract This case is of a young female with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent mechanical thrombectomy to temporize the condition until she could be evaluated by gynecology-oncologist to remove the cause of venous obstruction. Prior to hysterectomy, suprarenal inferior vena cava filter was placed. Less than 12 hours post hysterectomy she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

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Dual and Balloon-Assisted AngioJet Thrombectomy for Iliofemoral Deep Venous Thrombosis

10.1093/med/9780199986071.003.0038 ◽

2018 ◽

Author(s):

Zubin Irani ◽

Sara Zhao

Keyword(s):

Pulmonary Embolism ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Mechanical Thrombectomy ◽

Post Thrombotic Syndrome ◽

Thrombus Removal ◽

Phlegmasia Cerulea Dolens ◽

Extremity Veins

Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.

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Abstract 113: Streamlined Workflows for Triage and Transfer Reduce Door-to-Puncture Time in Mechanical Thrombectomy

Stroke ◽

10.1161/str.48.suppl_1.113 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Akash P Kansagra ◽

Adam N Wallace ◽

David Curfman ◽

James D McEachern ◽

Christopher J Moran ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Point Of Care ◽

Image Interpretation ◽

Single Session ◽

Time Intervals ◽

Process Improvements ◽

Neurological Outcomes ◽

Angiography Suite ◽

Trends Over Time ◽

Transferred Patients

Introduction: Rapid thrombectomy produces improved neurological outcomes in select patients with acute ischemic stroke. Here, we detail process improvements to reduce door-to-puncture (DTP) times in a multi-hospital network organized around an endovascular-capable center (ECC). Methods: A lean workflow was adopted to minimize time door-to-imaging and imaging-to-puncture time intervals. Key features of this workflow included minimalist and parallelized clinical and radiological evaluation with single-session CT and CT angiography (CTA) and point-of-care image interpretation, IV fibrinolysis in the CT suite for patients presenting to the ECC, pre-transfer IV fibrinolysis and CTA for patients transferred to the ECC, immediate transport from the CT suite to the angiography suite (potentially before neurointerventional team arrival), and minimalist setup in the angiography suite. DTP time was tracked between January 2015 and December 2015. Trends over time were characterized using a linear regression model. Results: The number of thrombectomies performed each quarter increased by 173% ( p =0.0017), and there was an increase in the proportion of transferred patients that underwent pre-transfer CTA ( p =0.0438) (Fig. 1). Quarterly median DTP time decreased by 74% (147 minutes to 39 minutes, p <0.0001); this decrease was greatest in transferred patients with pre-transfer CTA, in whom DTP time decreased 81% (129 minutes to 25 minutes, p =0.0008) (Fig. 2). Conclusions: Workflow improvements to streamline in-hospital evaluation at an ECC and perform critical workup such as CTA at referring hospitals before transfer to an ECC can dramatically improve DTP time. Fig. 1 Fig. 2

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Single-Session Percutaneous Mechanical Thrombectomy Using the Aspirex®S Device Plus Stenting for Acute Iliofemoral Deep Vein Thrombosis: Safety, Efficacy, and Mid-Term Outcomes

Diagnostics ◽

10.3390/diagnostics10080544 ◽

2020 ◽

Vol 10 (8) ◽

pp. 544

Author(s):

Romaric Loffroy ◽

Nicolas Falvo ◽

Kévin Guillen ◽

Christophe Galland ◽

Xavier Baudot ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Mechanical Thrombectomy ◽

Therapeutic Option ◽

Single Session ◽

Stent Patency ◽

Fluid Removal ◽

Venous Stenting ◽

Percutaneous Mechanical Thrombectomy ◽

Vein Thrombosis ◽

Deep Vein

To assess the safety, efficacy and mid-term outcomes of single-session percutaneous mechanical thrombectomy (PMT) for acute symptomatic iliofemoral deep vein thrombosis (DVT) using the Aspirex®S device. Retrospective review of 30 patients (women, 23; mean age, 45.5 ± 19.9 years; range, 17–76) who underwent PMT with the 10-French Aspirex®S device (Straub Medical AG, Wangs, Switzerland) for acute DVT between December 2015 and March 2019. Procedures were performed by popliteal (n = 22) or jugular (n = 7) approach, or both (n = 1). Mean time from diagnosis to PMT was 5.5 ± 4.6 days (range, 2–11). Successful thrombus removal and venous patency restoration were achieved in all patients (100%). Fluid removal was 307.8 ± 66.1 mL (range, 190–410). Additional venous stenting rate was 100%. Mean procedural time was 107.3 ± 33.9 min (range, 70–180). No major complication occurred. The patient’s postprocedural course was uneventful in all cases, with hospital discharge within 2 days in 83.3%. Early in-stent rethrombosis occurred within 1 week in 3 patients, successfully managed by endovascular approach. Secondary stent patency rate was 86.7% at a mean follow-up of 22.3 ± 14.2 months (range, 6–48), as assessed by Duplex ultrasound. Single-session of PMT using the Aspirex®S device is a safe and effective therapeutic option in patients presenting with acute symptomatic iliofemoral DVT.

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A Case of Phlegmasia Cerulea Dolens in a patient with COVID-19, effectively treated with fasciotomy and mechanical thrombectomy

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.07.034 ◽

2021 ◽

Author(s):

Josue R. Gutierrez ◽

Panagiotis Volteas ◽

Edvard Skripochnik ◽

Apostolos K. Tassiopoulos ◽

Mohsen Bannazadeh

Keyword(s):

Mechanical Thrombectomy ◽

Phlegmasia Cerulea Dolens

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Delayed Yet Successful Mechanical Thrombectomy for Phlegmasia Cerulea Dolens in a Limb with Severe Arterial Disease and May-Thurner Syndrome

Case Reports in Vascular Medicine ◽

10.1155/2020/8866030 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ahmad Said ◽

Phillip Kraft ◽

Luay Sayed

Keyword(s):

Spinal Surgery ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Arterial Disease ◽

Iliac Vein ◽

Percutaneous Mechanical Thrombectomy ◽

Life Threatening ◽

Iliac Vein Compression ◽

Life Threatening Complication ◽

Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens (PCD) is a rare but life-threatening complication of acute deep venous thrombosis that lacks consensus regarding the approach to management. We present a case of PCD developing shortly after a spinal surgery and manifesting as acute swelling and discoloration in a leg with existing severe atherosclerotic arterial disease. The patient’s critical limb ischemia was completely and rapidly reversed by percutaneous mechanical thrombectomy using the ClotTriever device despite a delay in treatment. An underlying iliac vein compression “May-Thurner” syndrome was discovered using intravascular ultrasound and treated with angioplasty. This case identifies mechanical thrombectomy using the ClotTriever system as a possible effective and safe treatment for PCD.

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Upper limb phlegmasia cerulea dolens treated with single-session suction thrombectomy: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa364 ◽

2020 ◽

Vol 2020 (10) ◽

Author(s):

Paul Ghaly ◽

Glen Schlaphoff ◽

John Crozier ◽

Mehtab Ahmad

Keyword(s):

Upper Limb ◽

Rare Condition ◽

Sudden Onset ◽

Lower Limbs ◽

Single Session ◽

Vessel Patency ◽

Clinical Triad ◽

Phlegmasia Cerulea Dolens

Abstract Phlegmasia cerulea dolens (PCD) of the lower limbs is a rare condition. PCD of the upper limbs is extremely uncommon, with only a select few cases documented in the literature. A complication of severe deep venous thrombosis, PCD, is characterized by the clinical triad of oedema, pain and limb cyanosis. Delays in treatment are associated with high rates of morbidity and mortality. We present a case of sudden-onset upper limb PCD in a 68-year-old man following haemodialysis through a long-term arteriovenous fistula. Prompt diagnosis and rapid initiation of intravenous anticoagulation followed by urgent single-session suction thrombectomy resulted in the successful restoration of vessel patency without any significant adverse sequelae on 3-month follow-up.

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