132 - Review of Mechanical Thrombectomy Devices for Interventional Management of Venous Thromboembolism
Shriya Veluri, BS – Medical Student, University of Texas Health Science Center San Antonio Joe R. and Teresa Lozano Long School of Medicine; Jesus Beltran, MD – PGY 6, Interventional Radiology, University of Texas Health Science Center San Antonio Joe R. and Teresa Lozano Long School of Medicine; Arthur Joseph, DO MPH – Assistant Professor, University of Texas Health Science Center San Antonio Joe R. and Teresa Lozano Long School of Medicine; Andrew Chesley, MD – Assistant Professor, University of Texas Health Science Center San Antonio Joe R. and Teresa Lozano Long School of Medicine
Purpose: Venous thromboembolism (VTE) is a life-threatening condition with a large global burden of disease. Three primary treatment options can be considered for patients with VTE: systemic anticoagulation, surgical management, and endovascular therapy. Mechanical thrombectomy (MT) has emerged as a valuable endovascular technique, particularly for complex or refractory cases where traditional thrombolytic therapy is less effective, such as older, chronic thrombi. Mechanical thrombectomy devices (MTDs) are designed to remove, fragment, or disperse thrombi in various venous territories and have strong potential to significantly improve patient outcomes. This exhibit reviews common MTDs and their mechanisms of action, indications for use, and overall contraindications as well as review cases in which their use can be demonstrated.
Material and Methods: MT cases performed through the IR department at UT Health San Antonio between January 2020 and January 2024 were retrospectively reviewed. Procedural and clinical details including location of thrombus, MTD used, and technical success were recorded. Device details and case examples demonstrating their role in VTE management are shown.
Results: The three most commonly used thrombectomy devices were Penumbra's Lightning Indigo system, Inari's FlowTriever system, and BD's Aspirex system. These devices were utilized for VTE management of acute thrombi and emboli in peripheral and pulmonary vasculature. MTD sizes ranged from 6-F to 22-F and from 50 to 150 centimeters working length and used mechanical and/or aspiration technologies to remove clots. While the Lightning Indigo and FlowTriever systems have no known contraindications, the Aspirex system is contraindicated for use in the cardiac, coronary, pulmonary, and neurovasculature vessels, limiting its application to venous systems. These devices also share few uncommon adverse effects, such as contrast reactions, vessel thrombosis, and complications at the vascular access site.
Conclusions: Each of the discussed interventions have unique indications that will allow providers to best tailor treatment approaches to the individual patient. These mechanical thrombectomy devices have become an essential component of IR’s armamentarium against venous diseases, offering a minimally invasive option that can lead to rapid symptom resolution, prevention of serious complications, and preservation of venous function.
