Ultrasound guided full mechanical thrombectomy of a floating thrombus in the common femoral vein

Abstract

A Floating Venous Thrombus (FVT) in the deep venous system has a high potential to cause pulmonary embolization. There are no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. Catheter-directed thrombolysis is effective for treatment of venous clots, but it is associated with increased risk of bleeding. Mechanical thrombectomy currently represents a valid therapeutic option without the need for lytic therapy and with excellent short and medium-term results. We herein present a technical note through an explicative case of a patient with an FVT located in the left common femoral vein who underwent to percutaneous venous mechanical thrombectomy (ClotTriever, Inari Medical, Irvine, CA, USA) under ultrasound guidance without an intravascular ultrasound check. At the end of the treatment, venography and duplex ultrasound scan showed ilio-femoral patency without residual thrombus. No further procedures were needed and the patient was discharged two days post-intervention with oral anticoagulation and compression therapy with stockings.