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Coronal LAVA postcontrast demonstrating thrombus in left common iliac vein with lack of internal enhancement.
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An MRI could not differentiate between bland and tumor thrombus due to lack of definite enhancement, although tissue invasion from the chordoma was noted (Fig. 1).
Extirpated matter from the first mechanical thrombectomy procedure using the Inari ClotTriever catheter.
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The extracted specimens were placed into formalin and submitted to pathology (Fig. 2).
Hematoxylin and eosin staining of submitted specimen under 100x microscopy demonstrating myxoid matrix with nests of tumor cells with a physaliphorous, or bubbly and vacuolated, appearance. In the background there is fibrin and necrosis. Sample conclusive for sacral chordoma.
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The patient tolerated the procedure well and reported significant improvement in symptoms by postprocedure day 5. The final pathologic diagnosis of the specimen obtained from the left CIV was conclusive for sacral chordoma (Fig. 3).
Picture of patient's legs with recurrent symptoms of swelling and pain, prior to second thrombectomy with stent placement.
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Six weeks later, the patient experienced recurrent left lower extremity swelling (Fig. 4).
Image during second mechanical thrombectomy and stent placement. Initial venogram demonstrating recurrent occlusion in left CIV/EIV.
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Venography confirmed thrombus in the left CIV and EIV (Fig. 5).
Image during second procedure. Improved flow following thrombectomy and stent placement without residual stenosis or flow limitation.
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CA) was then deployed within the left CIV and EIV and angioplastied with 16 and 18 mm balloons. Completion venography demonstrated a patent stent-graft without evidence of residual filling defects or stenosis (Fig. 6).