Chronic Venous Intervention Using a Large-Bore, Vacuum-Assisted Aspiration System: A New Era?

BACKGROUND

Chronic venous thromboembolism can affect various vascular beds and is often treated medically. Although endovascular intervention is an option, it is challenging with currently available equipment and revascularization techniques.

CASE SUMMARY: Patient 1 presented with superior vena cava obstruction due to a thrombosed superior vena cava graft after thymectomy. Successful revascularization was achieved using both the Symphony aspiration catheter (Imperative Care) and the ClotTriever catheter (Inari), with placement of an additional covered stent. There was immediate resolution of symptoms. Patient 2 had a history of implantable cardioverter-defibrillator insertion, who presented for chronic pulmonary embolism. Symphony catheter aspiration yielded both chronic thrombus and organized tissue. She was later diagnosed with an implantable cardioverter-defibrillator infection, complicated with septic pulmonary embolization. She was further managed with lead extraction, percutaneous vegetation aspiration and antibiotics.

TAKE-HOME MESSAGE: With newer generation devices, chronic venous intervention is becoming more feasible and could potentially be offered to more patients who fail medical therapy.