(CS-053) Novel mechanical thrombectomy device used to restore patency to chronically occluded femoral to caval bypass to heal venous ulcers

Chronic iliac vein and inferior vena cava occlusion caused by long standing venous thrombosis can lead to chronic venous insufficiency and venous ulcerations.  Endovascular technologies have emerged as the first line treatment for deep venous occlusions, but venous bypass can be considered if endovascular treatments fail. We report the two cases of chronically occluded femoral-caval bypasses that were successfully thrombectomized using a new technology designed for occluded iliofemoral venous stents.

Methods:

Retrospective chart review was performed, and we identified two patients with post-thrombotic syndrome and venous ulcers, who were treated for thrombosed femoral-caval bypasses for chronic iliac vein and vena cava occlusions using a novel mechanical thrombectomy device between March 2023 and October 2023. Baseline demographic data was obtained including patient age, past medical history, preoperative diagnoses, clinical symptoms, CEAP classification and imaging. Postoperatively clinical symptoms were examined through chart review. Venous ulcers went on to heal in both patients following revascularization.

Results:

Both patients were male with longstanding history of post-thrombotic syndrome with venous stasis ulcers. Both had prior iliac vein stent placement with failure due to thrombosis. Both patients had undergone femoral-caval bypasses to restore venous outflow, manage edema, and heal chronic venous ulceration, however, despite therapeutic anticoagulation for the polytetrafluoroethylene (PTFE) bypasses, both bypasses thrombosed. A novel mechanical thrombectomy device was used to perform mechanical thrombectomy of the chronically occluded femoral to caval bypass, thereby restoring venous return to the caval system. Both patients went on to rapidly heal their lower extremity ulcers and resolve their swelling.

Discussion:

These cases exemplify the ability to use novel mechanical thrombectomy devices to revascularize chronically occluded PTFE bypasses and restore venous outflow for patients who suffer from post thrombotic syndrome. We present the first two cases performed in the world of this kind to aid in healing venous ulceration from post-thrombotic syndrome.