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.

The popliteal vein was punctured under USS, and a 10fr sheath inserted.
8000u heparin was given.

A Cook Celect temporary infrarenal caval filter was inserted.

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