PMC10457166_01
Preoperative computed tomography angiography (CTA) confirming the diagnosis of inferior vena cava and right proximal iliac vein thrombosis. (a) The black arrows mark the ECMO cannula prior to decannulation localized in the inferior vena cava. (b, c) After removal of the venous ECMO cannula, CTA shows extensive thrombosis of the inferior vena cava and the proximal right iliac vein as highlighted by the red box. (d) Subtotal occlusion of the inferior vena cava at the level of the liver is highlighted by the red circle. (e) Subtotal occlusion of the vessel lumen next to the heterotopic kidney transplant (* marking the kidney transplant).
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fig1
A 46-year-old female was admitted due to a subtotal thrombotic occlusion of the entire IVC and the proximal right common iliac vein after decannulation from extracorporeal life support which was confirmed by computed tomography angiography (CTA) (Figure 1).
Setup of the AngioVac system. (a) Depicted is the primed extracorporeal circuit prior to connection to the patient. (b) Focused view of the filter and the centrifugal pump. (c) Schematic illustration of the application of the AngioVac system in combination with the Cleaner 15  rotational thrombectomy device. In this case, due to thrombus formation in the inferior vena cava and the right iliac vein, the suction cannula was introduced into the right jugular vein, and venous return was administered via the left femoral vein. The rotational thrombectomy device was introduced via the right femoral vein. The dotted area shows the released sinusoidal wire of the thrombectomy device just distally of the AngioVac suction cannula.
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fig2
The setup used in this case is shown in Figure 2.
Pre- and postinterventional venogram of the inferior vena cava. (a) Preoperative venogram shows a subtotal occlusion of the inferior vena cava. The asterisk marks the remaining lumen of the IVC. (b) After the procedure, the lumen of the inferior vena cava is restored. The dotted cone shows the tip of the suction cannula.
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fig3
IVC via the same access. In line with preoperative diagnostic studies, the venogram revealed a subtotal thrombotic occlusion of the IVC and the proximal right common iliac vein (Figure 3(a)). In order to evaluate the procedural success, another venography was performed which showed almost complete removal of the thrombotic material (Figure 3(b)).
Mobilization of wall-adherent thrombus with the rotational thrombectomy device. (a) The funnel at the tip (dotted cone) of the AngioVac cannula is positioned just proximal to the tip of the Cleaner 15  thrombectomy device. Note that the sinusoidal wire has been released from the catheter of the rotational thrombectomy device. (b) Under continuous aspiration of the AngioVac system, the rotational thrombectomy device is engaged, and the sinusoidal wire rotates within the vessel. The white ellipsoid shows the rotating action of the sinusoidal wire.
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fig4
AngioVac cannula was placed just cranially to the tip of the released sinusoidal wire of the rotational thrombectomy device (Figure 4(a)). The thrombectomy system was engaged under continuous aspiration, and the wall-adherent thrombus in the IVC and the right iliac vein were mobilized (Figure 4(b)) and simultaneously evacuated. After the thrombotic material was safely removed (Figure 5), the extracorporeal circulation was discontinued.
Thrombotic material found in the filter of the extracorporeal circuit after the procedure. Pathologic examination showed that the aspirated thrombus material consisted of fibrin with a moderate amount of erythrocytes. No bacterial growth was detected during microbiological testing.
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fig5
AngioVac cannula was placed just cranially to the tip of the released sinusoidal wire of the rotational thrombectomy device (Figure 4(a)). The thrombectomy system was engaged under continuous aspiration, and the wall-adherent thrombus in the IVC and the right iliac vein were mobilized (Figure 4(b)) and simultaneously evacuated. After the thrombotic material was safely removed (Figure 5), the extracorporeal circulation was discontinued.