[Percutaneous transjugular thrombectomy in iliocaval thrombosis-- initial experience with a newly developed 12F balloon sheath].

PURPOSE: To evaluate the feasibility of percutaneous thrombectomy for the removal of floating iliocaval thrombi using a balloon sheath.

MATERIALS AND

METHODS

A newly developed balloon sheath (inner diameter: 12-F; outer diameter: 18-F) was tested in two patients with extensive iliocaval thrombosis. Mechanical thrombectomy was performed due to recurrent pulmonary embolism under therapeutic anticoagulation in antiphospholipid-antibody syndrome and, respectively, paraneoplastic thrombosis without a decrease of fresh thrombus mass in spite of pharmacological treatment. Via a transjugular access (20-F), the sheath was advanced retrogradely into the inferior vena cava. After blocking of the vessel, mechanical fragmentation was performed through the working channel coaxially, using a temporary vena cava filter as a rotating basket (max. diameter: 30 mm). Residual thrombus fragments were removed by aspiration.

RESULTS

The thrombectomy balloon sheath tested allowed a complete removal of fresh thrombi after fragmentation. In addition, older clot material was obtained. Balloon occlusion prevented the central embolization of thrombus fragments. Clinical signs indicating pulmonary embolism were not seen. The fluid loss due to aspiration was negligible.

CONCLUSIONS

The newly developed 12-F balloon sheath proved to be efficient for the extraction of large thrombi. Balloon occlusion safely prevented central embolization of thrombus fragments proximal to the sheath.