A case report of percutaneous mechanical thrombectomy with retrograde approach for the treatment of acute lower limb deep vein thrombosis: Is it safe?
Main Article Content
Keywords
Case report, deep vein thrombosis, percutaneous mechanical thrombectomy, retrograde approach
Abstract
Introduction: Deep vein thrombosis (DVT) is a type of venous thromboembolism. In recent years, an invasive approach with active thrombus removal with an antegrade approach has been suggested as an alternative to conventional medical treatment for acute DVT. Here, we report an uncommon Percutaneous mechanical thrombectomy (PMT) treatment for DVT with a retrograde approach.
Case description: A 28-year-old female presented with pain and swelling in the right leg for 9 days after a 10-hour flight. D-Dimer was elevated (3.24 ng/mL). Doppler USG revealed DVT involving the superficial femoral, popliteal, and peroneal veins, as well as superficial vein thrombosis at the saphenopopliteal junction and small saphenous vein. The patient received heparinization, followed by venogram, IVC filter implantation, and PMT via retrograde femoral vein access with a good clinical outcome. In this case, catheter access via antegrade failed, and retrograde via the right femoral vein was used. The retrograde venous approach also has several advantages, including a shorter procedure time due to the larger diameter of the proximal vein and fewer anatomical variants. There are also disadvantages, namely valve injury, as the direction of access is opposite to the direction of blood flow. IVC filter implantation is performed before thrombectomy with the aim of protection against PE caused in part by thrombus fragmentation during the thrombectomy.
Conclusion: Mechanical thrombectomy can be performed using a retrograde approach. The retrograde approach is safe and effective with no significant difference in technical success.
References
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