Juri Bassuner, MD
UT Health Science Center at Houston
Disclosure(s): No financial relationships to disclose
Rakesh S. Ahuja, MD
Assistant Professor, Vascular & Interventional Radiology
University of Texas Health Science Center Houston, McGovern Medical School, Department of Vascular and Interventional Radiology
To review and familiarize the reader with the myriad of new thrombectomy devices approved for central and peripheral venous vasculature including indications for use, advantages and disadvantages, and practical tips for use.
Endovascular thrombectomy devices for treatment of acute clot in the setting of DVT, PE, as well as AVF and AVG thrombosis have developed at a rapid rate over the last few years. Recent iterative improvements have been made on existing thrombectomy devices and completely new devices have been introduced.
The newest version of Inari Medical FlowTriever 2 features a single expanding disc that covers a range of sizes, simplifying the choice of three different sizes with the previous generation. The more rigid basket of the ClotTriever BOLD has greater radial strength than the original ClotTriever for better wall apposition. Inari Medical FlowSaver and Penumbra Lightning Aspiration Tubing are ancillary devices used in combination with their respective thrombectomy devices to reduce intra-procedural blood loss. Penumbra CATD is a specifically designed for short access and sized for use in AVF and AVG declotting. Angiodynamics AlphaVac and BD Aspirex are new aspiration device used in the central and peripheral veins, respectively.
With improved technology comes new devices and associated learning curves. Choosing the correct thrombectomy device is sometimes a matter of preference but nonetheless important for achieving optimal results. Intervention should be guided by clinical grading systems when possible. In general, thrombectomy of acute clot is best achieved if performed within two weeks of onset, before chronic changes have occurred. Thrombectomy can often be aided by thrombolysis to soften and partially resolve clot.