AngioJet™

Ultra Thrombectomy System

Case Study:

Deep Vein Thrombosis

Thrombectomy of Massive DVT

35 year old female patient with metastatic endometrial sarcoma and severely swollen left leg.
Symptomatic DVT
Severely swollen left leg despite wearing class 2 thigh high compression stockings. Note nephrostomy drainage catheter bag.
Pre Treatment
Venogram of left leg showing occlusive thrombus involving most visualised deep veins.
Pre Treatment
Venogram of left leg showing occlusive thrombus involving most visualised deep veins.
Pre Treatment
Prone venogram of left iliac indicating stenosis caused by tumour compressing both ureter and left external iliac vein.
Reasonable thrombus removal in Iliac Veins following single pass of AngioJet DVX catheter (25mg tPA in 250cc Normal Saline)
Final venogram following aspiration with large catheter, and treatment of underlying stenosis (due to extrinsic compression from tumor) with 16mm stent ballooned to 12mm.
Total time < 90 minutes. Perfect inline flow from back of knee to IVC.
At 4.5 months, normal ambulation, no swelling.
Gerard O’Sullivan - University College Hospital, Galway, Ireland - 2009

Thrombectomy of Bilateral DVT

76 year old male with bilateral lower limb swelling and previous IVC filter. Recently removed (infected) left total hip replacement and bed rest for 2 months. Likely right leg DVT x 6 weeks, left iliac vein thrombus x 6 days.
Axial CT venography showing acute thrombus from IVC filter  down into right external and internal iliac vein, and left common iliac vein.
Coronal CT venography showing acute thrombus from IVC filter down into right external and internal iliac vein, and left common iliac vein.
Pre Treatment
Prone venogram showing occlusive acute thrombus from right popliteal vein extending up to IVC filter.
Pre Treatment
Prone venogram showing occlusive acute thrombus from right popliteal vein extending up to IVC filter.
Venography post bilateral venous thrombolysis and thrombectomy; thrombus removal post single pass AngioJet DVX catheter (Rapid Lysis technique; 25mg tPa @1mg/ml +  225cc N saline = 250cc solution)
Venography post bilateral venous thrombolysis and thrombectomy; thrombus removal post single pass AngioJet DVX catheter (Rapid Lysis technique; 25mg tPa @1mg/ml +  225cc N saline = 250cc solution)
Post AngioJet DVX catheter, aspiration and stenting with 14mm x 150mm stents. Result on approximately 2 month old right leg thrombus. Further PTA of R EIV required.
Gerard O’Sullivan - University College Hospital, Galway, Ireland - 2009

Thrombectomy of DVT

44 year old female with acute swelling of left leg.

Treatment plan:

  • Left popliteal access
  • AngioJet Thrombectomy on affected areas
  • Stent May Thurner lesion
Colour Doppler US demonstrates left common femoral vein thrombus.
Popliteal access; prone view of acute occlusive thrombus in left popliteal vein, femoral vein.
Popliteal access; prone view of acute occlusive thrombus in left common femoral vein and iliac veins.
Duplicated left femoral vein, left common femoral vein and EIV CIV post thrombectomy using AngioJet Solent catheter; 25mg tPa in 250cc saline (Rapid Lysis) and 14mm stent.
Duplicated left femoral vein, left common femoral vein and EIV CIV post thrombectomy using AngioJet Solent catheter; 25mg tPa in 250cc saline (Rapid Lysis) and 14mm stent.
Implanted 14mm stent.
Left leg shows considerably less swelling post treatment.
Gerard O’Sullivan - University College Hospital, Galway, Ireland - 2009

Thrombectomy of DVT

Colon cancer patient with acute left leg swelling.
Pre Treatment
Prone view showing acute thrombus in left common femoral vein, and no flow into iliac veins.
Pre Treatment
Prone view showing acute thrombus in left common femoral vein, and no flow into iliac veins.
Prone view of left leg post thrombectomy using AngioJet DVX catheter, using the Rapid Lysis technique (25mg tPa in 250cc N saline). No remaining thrombus, underlying occlusion of left common iliac vein revealed.
Close up view of stents.
Close up view of stents.
Completion angiogram reveals rapid in line flow into IVC from femoral vein injection.
Gerard O’Sullivan - University College Hospital, Galway, Ireland - 2009
Left ileofemoral DVT with May-Thurner syndrome.
CT venography with critical stenosis of left common iliac vein (May-Thurner syndrome).
Venography of superficial femoral vein before treatment.
Venography of common femoral and pelvic veins before treatment.
Rapid lysis technique using Solent Omni with alteplase in the superficial femoral vein.
Result post activation of Solent Omni for 190 sec (rapid lysis technique).
Rapid lysis technique using Solent Omni with alteplase in the external iliac vein.
Result post activation of Solent Omni for 190 sec (rapid lysis technique).
Superficial femoral vein post adjunctive Catheter Directed Thrombolysis with alteplase for 18 hours.
Critical stenosis of common iliac vein with collaterals (May-Thurner syndrome).
Free outflow with no collateralls following stent deployment in common iliac vein.
Dr. Ivan Vulev - Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia, 2014

Thrombectomy of Massive Iliofemoral DVT and Stenting for May-Thurner Syndrome

44 year old female patient with massive left iliofemoral DVT following hysterectomy for multiple fibroids. Supine venogram from right common femoral vein prior to temporary cava filter insertion indicating protruding thrombus from left common iliac vein.
Cavogram after temporary filter placement in inferior vena cava showing protruding floating thrombus extending from left common iliac vein.
Venogram in prone position of left femoral vein showing massive thrombus within vein lumen.
Venogram in prone position showing thrombus occlusion of femoral and iliac veins.
Femoral vein venography after pharmacomechanical thrombectomy (PMT) using Power Pulse Delivery technique (used 15 ml from a solution of 50mg tPA  in 500 ml NS) followed by 2 passes with AngioJet DVX catheter.
Supine venography following 2 passes with AngioJet DVX catheter. Patent external iliac vein, common femoral vein. Tight stenosis of common iliac vein.
Venography of left common iliac vein after stenting with 12x100mm stent, PTA 10x60mm. Total procedure time 105 minutes.
Final venography after pharmacomechanical thrombectomy (PMT), stenting of common iliac vein and removal of filter from IVC.
Karlo Novacic - Department of Interventional Radiology, Clinical Hospital Merkur, Zagreb, Croatia - 2013.

Acute Left leg Ilio femoral DVT managed with AngioJet TM Thrombectomy System and Wallstent Uni TM endoprothesis

27 year old female. Risk factor: oral contraceptive pill. 7 days of leg pain and discolouration. Worsening swelling. On examination 6cm size difference between thighs.
CTV of Left CFV demonstrating a low attenuation, swollen left common femoral vein compared with a normal right side.
Initial angiogram of  L CFV indicating extensive DVT (pt prone).
AngioJet Solent used in isovolumetric rapid lysis mode with 20mg tPA in 180cc Normal saline.  Two passes in total over 8 minutes.
Post AngioJet L iliac veins. Excellent result, showing vessel patency.
Post AngioJet, iliac vein completely free of thrombus, and clear indication of venous stenosis (May-Thurner syndrome).
Wallstent 14/90mm  ballooned to 14mm at 14 atm. Satisfactory position and expansion.
Final appearances demonstrate excellent in line flow through the femoral and iliac system post  AngioJet  venous thrombectomy and Wallstent placement.
Final appearances demonstrate excellent in line flow through the femoral and iliac system post  AngioJet  venous thrombectomy and Wallstent placement.
Gerard O’Sullivan - University College Hospital, Galway, Ireland -  April 2015.
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