ABSTRACT
OBJECTIVES: Although filtered blood reinfusion (FBR) can be implemented during aspiration thrombectomy for pulmonary embolism (PE), the effectiveness and risks of this technique remain unknown. The purpose of this study was to assess how utilization of FBR affects procedural outcomes. MATERIALS AND METHODS: A total of 171 patients who underwent aspiration thrombectomy for intermediate-high or high risk PE between December 2018 and September 2022 were included, 84 of whom underwent thrombectomy with FBR and 87 without. Demographic data, vital signs, laboratory values, procedural details, pulmonary arterial pressures, transfusion needs, length of hospital stay, and procedure-related complications were recorded. RESULTS: The groups did not differ at baseline, other than the FBR cohort having a higher percentage of females. There was no significant difference in post-procedural vitals or pulmonary arterial pressure. Mean fluoroscopy time and volume of IV contrast were lower in the FBR cohort. The drop in hemoglobin was lower in the FBR group at both 12 (FBR: -1.065; no FBR: -1.742, P: >0.001) and 24 hrs (FBR: -1.526; no FBR: -2.380, P: >0.001) post procedure; accordingly, fewer patients required transfusions in the FRB cohort (FBR: 8; no FBR: 20, P: 0.016). There was no difference in the number or severity of adverse events or duration of Intensive Care Unit or hospital admission. CONCLUSIONS: FBR use during aspiration pulmonary thrombectomy reduces blood loss and transfusion requirements but has no significant effect on surrogate markers of procedural success or adverse event rates.
ABSTRACT
PURPOSE: To analyze the first 250 patients from the prospective, multicenter, industry-sponsored ClotTriever Outcomes (CLOUT) registry, assessing the safety and effectiveness of mechanical thrombectomy for acute, subacute, and chronic deep vein thrombosis (DVT). MATERIALS AND METHODS: Real-world patients with lower extremity DVT were treated with the ClotTriever System (Inari Medical, Irvine, California). Adjuvant venoplasty, stent placement, or both were performed at the physician's discretion. Thrombus chronicity was determined by visual inspection of removed thrombus, categorizing patients into acute, subacute, and chronic subgroups. Serious adverse events (SAEs) were assessed through 30 days. Clinical and quality-of-life (QoL) outcomes are reported through 6 months. RESULTS: Thrombus chronicity was designated for 244 of the 250 patients (acute, 32.8%; subacute, 34.8%; chronic, 32.4%) encompassing 254 treated limbs. Complete or near-complete (≥75%) thrombus removal was achieved in 90.8%, 81.9%, and 83.8% of the limbs with acute, subacute, and chronic thrombus, respectively. No fibrinolytics were administered, and 243 (99.6%) procedures were single sessions. One (0.4%) patient in the subacute group experienced a device-related SAE, a fatal pulmonary embolism. On comparing baseline and 6-month data, improvements were demonstrated in median Villalta scores (acute, from 10 to 1; subacute, from 9 to 1; chronic, from 10 to 3; for all, P < .0001) and mean EuroQol group 5-dimension (EQ-5D) self-report questionnaire scores (acute, 0.58 to 0.89; subacute, 0.65 to 0.87; chronic, 0.58 to 0.88; for all, P < .0001). There were no significant differences in outcomes across the subgroups. CONCLUSIONS: Mechanical thrombectomy using the ClotTriever System with adjunctive venoplasty and stent placement is safe and similarly effective for acute, subacute, and chronic DVT.
Subject(s)
Thrombectomy , Venous Thrombosis , Humans , Thrombectomy/adverse effects , Treatment Outcome , Prospective Studies , Quality of Life , Thrombolytic Therapy , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy , Venous Thrombosis/etiology , Registries , Iliac Vein , Retrospective StudiesSubject(s)
Arteriovenous Shunt, Surgical/adverse effects , Ischemia/etiology , Kidney Failure, Chronic/therapy , Myalgia/etiology , Peripheral Nervous System Diseases/etiology , Radial Artery/surgery , Upper Extremity/blood supply , Embolization, Therapeutic , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Kidney Failure, Chronic/diagnosis , Myalgia/diagnosis , Myalgia/physiopathology , Myalgia/therapy , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/therapy , Physical Therapy Modalities , Radial Artery/diagnostic imaging , Radial Artery/physiopathology , Recovery of Function , Renal Dialysis , Treatment Outcome , Young AdultABSTRACT
The Inari ClotTriever system (Inari Medical, Irvine, California) is safe and effective for the treatment of DVT. However, because it consists of a 31 cm coring device and collection bag that must be extended for use, application may be precluded by available intravascular "running room", such as in the presence of an IVC filter. Here we present a technique for bypassing IVC filters via retrograde deployment of the ClotTriever within a sheath, as illustrated in three cases. This technique extends the applicability of the ClotTriever to locations in which its length would otherwise preclude use.
ABSTRACT
Inferior vena cava (IVC) filters should be removed when no longer needed, given their association with complications such as thrombosis of the IVC and lower extremities, fracture, migration, and growth into adjacent structures. While this is generally straightforward in the setting of retrievable filters, permanent filters present more of a challenge. In fact, many operators will not attempt to do so for fear of intraprocedural complications, among them, filter fracture and fragment embolization. Despite this, leaving the filters in situ places patients at risk of the complications described above. Here, the authors illustrate a novel technique for retrieving permanent filters using a funneled sheath to protect against embolization.