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To retrospectively evaluate the efficacy of single-session aspiration thrombectomy using large catheters without pharmacologic thrombolysis to treat acute and subacute lower extremity deep vein thrombosis (DVT).From January 2008 to December 2011, single-session aspiration thrombectomy using large, 11F introducer catheters to treat acute and subacute lower extremity DVT was performed in 74 limbs of 74 patients (M/F = 23/51, age range 36-88 years), and clinical and imaging follow-up of over 6 months were obtained in 26 patients. Causes of DVT were May-Thurner syndrome (n = 65), malignancy related (n = 6), and pelvic mass (n = 3). A 14F introducer sheath was inserted through the popliteal vein, followed by rotational thrombus maceration and aspiration thrombectomy. Angioplasty and stent placement were performed when needed. Radiological images and medical records were reviewed for immediate and midterm results, complications, and recurrences.Initial technical success rate was 89.2% (66 patients). Stenting was performed in 55 patients. The failures were due to underlying chronic thrombi/DVT (n = 7) and stent failure due to huge pelvic mass (n = 1). There was no procedure-related complication. In the 26 midterm follow-up patients for a duration of 6-48 months, there was no recurrence (n = 20), stent occlusion (n = 3), or femoral vein occlusion (n = 3). One-year primary patency rate in stent/iliac vein, femoral vein, and popliteal/infrapopliteal vein were 88.5, 88.5, and 96.2%, respectively.Single-session aspiration thrombectomy for acute and subacute lower extremity DVT using large introducer catheters without pharmacologic thrombolysis is feasible with acceptable immediate and midterm results, excluding complications related to pharmacologic thrombolysis.

Purpose: This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Methods: Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide® 6F, Abbott) was placed before arterial sheath (mean 9F, range 6-12F) introduction in 101 patients (74 men, 73%, mean age 70.1±12.6years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. Results: There were a total of 19 vascular complications (19%) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2%) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94%); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. Conclusions: With acceptable short- and mid-term outcomes, the "preclose” technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy

We report the case of a 31-year-old woman presenting with abdominal pain due to acute thrombosis of a superior and inferior mesenteric vein aneurysm, which was treated by a combination of arterial thrombolysis and transhepatic thrombus aspiration. At the last follow-up CT, 21 months following this procedure, there was no evidence of rethrombosis, and the patient continues to do well under oral anticoagulation. The literature regarding these uncommon mesenteric vein aneurysms without portal vein involvement, as well as their treatment options, is reviewed.

Aspiration thrombectomy supported by an oscillating metal probe within the catheter allows continuous aspiration of large thrombi without catheter obstruction. Thrombus aspiration assisted by an ultrasound-driven probe (frequency 26 kHz) and by an electric motor-driven probe (frequency 40 Hz) was compared in two different in vitro models: aspiration of large clots from a Petri dish and recanalization of thrombotic occlusions in a flow model. Comparable results were found for a 1 mm ultrasound-driven probe and a 0.5 mm motor-driven probe. The motor-driven device, however, seems to be more appealing for in vivo application because of its simplicity, probe flexibility, absence of thermal effects, and low cost.

A saline-jet aspiration thrombectomy (JAT) catheter was used in a patient with acute myocardial infarction. A right coronary arteriogram showed complete thrombotic occlusion at the proximal segment. With this catheter the thrombus was removed without complications in 5 sec. The patient underwent percutaneous transluminal coronary angioplasty and placement of a Palmaz-Schatz stent after successful thrombectomy. Thrombectomy with a JAT catheter was very useful in this patient.