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A previously well 55 year old lady presented to the Royal Free Hospital Vascular Service following a long aircraft flight with a markedly swollen tender leg.
Duplex ultrasound of the popliteal and calf veins showed extensive thrombosis, mainly low echoreflectivity fresh clot. The short saphenous was also thrombosed.
A Cook Celect temporary infrarenal
caval filter was inserted.
The popliteal vein was punctured under USS, and a 10fr sheath inserted.
8000u heparin was given.
Venogram show fresh clot extending the full length of the lower limb vessels
Catheter and wire crossed the thrombosed segment, and Trellis-8 pharmacomechanical thrombectomy (PMT) performed of the iliac and femoral segments. 20mg RTPA (confined by the balloons therefore not systemic) given over 20mins,
The Trellis® Peripheral Infusion System is an Isolated Thrombolysis catheter with two occluding balloons, drug infusion holes between the balloons, and mechanical drug dispersion capabilities. This pharmaco-mechanical combination provides focused treatment of thrombus within vessel
PMTachieved good thrombus clearance
A venous stenosis was identified in the iliac system and a 16×90 and 14×90 Wallstents deployed across
the CIA/IVCjunction ballooned to 12mm with Conquest.
Post procedure flowtron boots and thigh length stockings were used; the patient was mobilise early and LMW Heparin was given A duplex in 48h showed good flow across the iliacs The IVC filter was removed after 2 weeks