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Percutaneous mechanical rheolytic thrombectomy is an effective treatment option for deep vein thrombosis as well as arterial and graft thromboses. Acute pancreatitis, a rare complication of this technique, is described in this case report.
A 40-year-old man underwent AngioJet mechanical rheolytic thrombectomy for iliocaval deep vein thrombosis. He...
Context in source publication
Context 1
... was also some narrowing of the central right common iliac vein ( Figure 3). A 140 Â 14 mm Zilver Vena stent (Cook Medical, Bloomington IN, USA) was placed in the left common and external iliac veins and a 100 Â 14 mm Zilver Vena stent was placed in the right common iliac vein ( Figure 4). The proximal ends of the stents were deployed into the inferior vena cava. ...
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... 21,22 In cases of catheter-directed thrombolysis, and more specifically, percutaneous mechanical thrombectomy, the risk of developing free-heme induced pancreatitis has been associated with numerous factors e thrombus size, blood flow within the target vessel, procedure duration, baseline renal function. 2,23 The patient presented in this case was noted to have only a limited procedural time, however, was noted to have a larger thrombus and significant blood flow within the target vessel, which when combined with the patients underlying chronic kidney disease, likely contributed to acute pancreatitis following her procedure. Renal dysfunction limits heme clearance, thus allowing for increased free heme concentrations in the blood and resultant inflammatory cascade activation. ...
... Typically, symptoms of percutaneous mechanical thrombectomy-induced pancreatitis commence within 24 h of the procedure but may present as last as four days post-procedure. 23,24 Given the temporal relationship between the percutaneous mechanical thrombectomy and the development of acute pancreatitis, coupled with a negative, albeit limited workup for other causes of pancreatitis, our patient was given a diagnosis of percutaneous mechanical thrombectomy induced pancreatitis secondary to hemolysis. Prevention strategies including procedural time limitations, perioperative rehydration, and urine alkalization may prevent massive hemolysis and subsequent complications. ...
While parental or oral anticoagulation remains a mainstay of therapy for thrombosis, in sporadic clinical situations, percutaneous mechanical thrombectomy is favored. Percutaneous mechanical thrombectomy is a well-tolerated subtype of catheter-directed intervention resulting in thrombus breakdown and removal. This procedure combines endovascular mechanical thrombectomy in combination with pharmacologic thrombolysis allowing for a significant reduction in procedure time. Similar to other catheter-based procedures, common complications include hemorrhage, dissection, pseudoaneurysm, and perforations. Acute pancreatitis, in contrast, is a rare complication of percutaneous mechanical thrombectomy with only limited cases reported and is hypothesized to occur secondary to release of heme byproducts. Here, we present a case of acute pancreatitis following outpatient percutaneous mechanical thrombectomy of the left common iliac vein that ultimately required hospitalization, intensive care unit (ICU) admission, and standard medical management for pancreatitis.
... Moreover, a recently published Dutch trial failed to demonstrate significantly lower rates of post-thrombotic syndrome in patients with iliaco-femoral thrombosis occasionally ascending into the IVC treated with ultrasound-enhanced thrombolysis [94]. A lack of evidence also exists for percutaneous mechanical, rheolytic, and vacuum thrombectomy [95][96][97][98]. Compared to CDT these techniques are timesaving and may help to avoid bleeding complications. ...
... Compared to CDT these techniques are timesaving and may help to avoid bleeding complications. They proved useful and safe in acute iliaco-femoral thromboses occasionally ascending into the IVC [95][96][97][98][99][100][101]. ...
Inferior vena cava syndrome (IVCS) is caused by agenesis, compression, invasion, or thrombosis of the IVC, or may be associated with Budd-Chiari syndrome. Its incidence and prevalence are unknown. Benign IVCS is separated from malignant IVCS. Both cover a wide clinical spectrum reaching from asymptomatic to highly symptomatic cases correlated to the underlying cause, the acuity, the extent of the venous obstruction, and the recruitment and development of venous collateral circuits. Imaging is necessary to determine the underlying cause of IVCS and to guide clinical decisions. Interventional therapy has changed the therapeutic approach in symptomatic patients. This article provides an overview over IVCS and focuses on interventional therapeutic methods and results.
Background
Acute pancreatitis caused by Percutaneous Mechanical Thrombectomy treatment is extremely rare, and so far, no clinical report involving portal veins been reported. In the article, we summarize this unusual case and share our experience.
Methods
Percutaneous mechanical thrombectomy was performed for the patient who was diagnosed with portal vein thrombosis. Postoperatively, the patient was complicated by acute pancreatitis and received a series of medical treatments.
Results
During the first month of follow-up, the patient was free of any clinical symptoms or signs.
Conclusions
When performing Percutaneous mechanical thrombectomy therapy, it is crucial to grasp the time limit strictly, strengthen perioperative rehydration and urine alkalinization to prevent massive hemolysis and subsequent complications. Early detection and the early administration of therapy for this potentially severe complication are essential for obtaining good prognosis.
Objective
This study retrospectively evaluated the safety and efficacy of aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis (DVT).
Methods
All patients who underwent aspiration thrombectomy using 9F or 10F catheters for acute lower extremity DVT were included and analyzed. Aspiration thrombectomy was performed in all patients. Additional intravenous thrombolysis was performed in patients with residual thrombus, and stent placement was performed in patients with iliac vein compression syndrome.
Results
From October 2010 to September 2013, the study enrolled 68 patients (37 women, 31 men) with a mean age of 61.7 ± 7.8 years (range, 24-86 years). All patients presented with lower extremity swelling and pain, and the duration of symptoms ranged from 1 to 14 days. The DVTs involved popliteal-iliofemoral veins in 29 patients, iliofemoral veins in 31, and iliac veins in 8. Endovascular procedures were performed in all patients with a technical success rate of 100%. Aspiration alone was effective in 47 patients, and additional thrombolysis was required in the remaining 21. An additional stent was required in 32 patients. Significant improvement in presenting symptoms was achieved in all patients after the procedures, with a clinical success rate of 100%. There were no procedure-related or thrombolysis-related complications. The Villalta scores were <5 in 60 patients and from 5 to 9 in four patients. Primary and secondary patency rates were 89.1% (57 of 64) and 96.9% (62 of 64) at 1 year of follow-up.
Conclusions
Aspiration thrombectomy using a large-size catheter is safe and effective for acute lower extremity DVT.
