Jul 2026· JACC Case Reports· Vol 31, pp. 109135· 0 citations· 5 references
Medicine
TL;DR
The patient had a history of implantable cardioverter-defibrillator insertion, who presented for chronic pulmonary embolism, and was later diagnosed with an implantable cardioverter-defibrillator infection, complicated with septic pulmonary embolization.
Abstract
Background Chronic venous thromboembolism can affect various vascular beds and is often treated medically. Although endovascular intervention is an option, it is challenging with currently available equipment and revascularization techniques. Case Summary Patient 1 presented with superior vena cava obstruction due to a thrombosed superior vena cava graft after thymectomy. Successful revascularization was achieved using both the Symphony aspiration catheter (Imperative Care) and the ClotTriever catheter (Inari), with placement of an additional covered stent. There was immediate resolution of symptoms. Patient 2 had a history of implantable cardioverter-defibrillator insertion, who presented for chronic pulmonary embolism. Symphony catheter aspiration yielded both chronic thrombus and organized tissue. She was later diagnosed with an implantable cardioverter-defibrillator infection, complicated with septic pulmonary embolization. She was further managed with lead extraction, percutaneous vegetation aspiration and antibiotics. Take-Home Message With newer generation devices, chronic venous intervention is becoming more feasible and could potentially be offered to more patients who fail medical therapy.
Novel adjuvant hemostatic agents are increasingly used in surgical procedures to achieve hemostasis. We present a case of embolisation of hemostatic agents during a neurosurgical operation, causing massive PE requiring venoarterial extracorporeal membrane oxygenation support, in a 7‐year‐old boy. Embolectomy was performed using the Penumbra 0.072” catheter with aspiration of blood clots alongside gelatinous clumps of Spongostan and thrombin, leading to angiographic and clinical improvement. A Cook MPA angiographic 5FR catheter and Terumo 0.035” wire were used for catheter repositioning between aspiration attempts. The following day, the patient was weaned from extracorporeal membrane oxygenation, and a day later, he underwent successful extubation. Catheter embolectomy with the Penumbra System can provide safe, rapid relief to a failing right ventricle in cases of massive PE caused by Spongostan.
Talya Finke, Oshry Mozes, Itai M. Pessach et al.· Catheterization and cardiova...· 0 citations
Autonomous or semi‑autonomous "autonomous vascular access" (AVA) platforms have the promise to standardize technique, accelerate placement by a wider range of providers, extend cannulation capability to austere settings, and reduce complication‑related morbidity.
Joel Grunhut, Patrick Walker, Meredith Lackie et al.· Military Medicine· 0 citations
BACKGROUND
Ascites commonly results from portal hypertension, malignancy, or cardiac disease. Systemic venous obstruction is an uncommon mechanism.
CASE SUMMARY
A 40-year-old woman with 2 prior kidney transplants, remote venous thromboembolism, and small bowel adenocarcinoma presented with recurrent ascites. Imaging revealed chronic superior vena cava (SVC) occlusion with collateralization to the inferior vena cava (IVC), IVC stenosis, and left iliac vein stenosis. Hemodynamics showed elevated SVC pressure, gradient from the left femoral vein to the IVC, and normal right atrial pressure. She underwent staged endovascular recanalization and stenting of the SVC, IVC, and left iliac vein, with repeated interventions for restenosis.
DISCUSSION
Multilevel systemic venous obstruction can produce clinically significant ascites through venous hypertension. Symptom relief is possible, but may require technically complex recanalization and repeat interventions.
TAKE-HOME MESSAGES
Systemic venous obstruction should be considered in unexplained refractory ascites. Endovascular therapy can be effective, but often necessitates repeat procedures.
A. Ardehali, T. Acharya, D. Acharya et al.· JACC Case Reports· 0 citations
BACKGROUND
Residual venous obstruction and in-stent restenosis (ISR) are common and challenging complications that may occur after interventional procedures performed for acute deep vein thrombosis (DVT) or chronic ilio-femoral venous obstruction. A novel fully integrated thrombectomy system (Recana Thrombectomy Device, RTD) was designed to treat (ISR) and native vessel obstructions. The system includes a debulking catheter, collection baskets, and a family of sheaths (Figure 1). This report describes its use in animal models of native and stented veins to assess safety compared to currently available thrombectomy devices.
METHODS
The RTD was studied in comparison to 2 currently marketed thrombectomy devices, the Argon CLEANER 15™ (CLEANER) and the Inari ClotTriever® (ClotTriever). Devices were studied in a porcine iliac vein model used in a manner consistent with Good Laboratory Practice for Nonclinical Laboratory Studies. 26 iliac veins in 13 animals were studied to evaluate performance in normal veins (9 animals, 18 iliac veins) and in 4 animals with 8 iliac veins pre-treated with iliac stents implanted 21 days prior to device treatment. Twelve normal iliac veins were treated with the RTD, 4 normal veins were treated with CLEANER and 2 with the ClotTriever. Five pre-stented iliac veins were treated with the RTD, and 3 pre-stented veins were treated with the CLEANER. Procedures were completed under fluoroscopic and IVUS guidance. For each model, both iliac veins were treated with 10 passes of the test or control thrombectomy device through the length of the common and external iliac veins. Survival and sacrifice periods were completed at varied timepoints to evaluate peak histological injury potential, vein wall healing and vein patency. Necropsy was performed at 5 ± 2 days or 30 ± 2 days after catheter intervention for gross evaluation of the iliac veins and other related tissues. Histology was performed on representative sections of treated iliac veins to evaluate wall damage, thrombosis, or other effects of intervention.
RESULTS
All animals survived to their designated endpoints with no unexpected mortality. One common femoral vein access complication led to unilateral perivenous hematoma and thrombosis. Another animal showed post-intervention venous constriction with eventual vessel occlusion. All other iliac veins (n=24) remained patent without significant stenosis at necropsy. No clinically relevant lacerations, perforations, or hemorrhagic events were observed with either the Test or Control devices. Histology revealed intimal disruption and inflammation with all devices, more pronounced with the RTD compared to CLEANER but similar to those seen after use of the ClotTriever. Mild perivenous bruising occurred in some Test device cases, without evidence of transmural bleeding.
CONCLUSIONS
In an in-vivo model of stented and native iliac veins, a novel venous tissue debulking system was able to engage intraluminal material without serious injury. Vein wall trauma was comparable to a commonly used mechanical thrombectomy device, with no transmural lacerations or device-related hemorrhage. These findings support continued development toward initial clinical trials in patients with venous obstruction.
William A. Marston, Eric Dooley, A. Chinubhai· Journal of Vascular Surgery:...· 0 citations
Introduction The placement of central venous catheters (CVC) is a common procedure for the administration of chemotherapy. Adverse events include malposition or displacement; there are limited reports of misplaced implanted CVCs. Case Report A 59-year-old female with a history of recently diagnosed metastatic small cell lung cancer, hypertension, former tobacco use of over 60 pack-years, and chronic obstructive pulmonary disease without chronic hypoxemic respiratory failure presented to the emergency department following the first outpatient infusion of chemotherapy. She developed acute onset dyspnea, moderate respiratory distress, and hypoxemia. She was found to have a malpositioned subclavian implanted (ie, “port”) CVC that was placed under fluoroscopy the week prior with placement confirmed by chest radiograph. The evaluation revealed a large right pleural effusion secondary to unintentional intrapleural infusion of chemotherapy. The patient was transferred to a tertiary-care center with successful clinical improvement after drainage of the effusion via tube thoracostomy. Conclusion We present an uncommon diagnosis of a chemothorax from a malpositioned central venous catheter in the thorax, despite a radiograph suggesting correct placement, and infusion of chemotherapy causing a common complaint of shortness of breath. This case highlights the limitations of radiographic confirmation of CVCs and a resultant complication from malpositioning.
Hannah E. Miller, Skyler A. Lentz· Clinical Practice and Cases...· 0 citations
Background Systemic thrombolysis is often not an option for elderly patients with PE because of bleeding risk. Large-bore catheters (16F−24F) can injure fragile vessels. The 6F Guidezilla guide extension catheter, already used in coronary cases, offers a smaller-caliber choice for thrombus aspiration and local thrombolysis. We report six elderly patients with high-risk PE treated with this approach. Methods Six consecutive patients with intermediate-high or high-risk PE underwent thrombus aspiration and in situ thrombolysis through a 6F Guidezilla catheter (March 2024 to January 2026). Agents used: recombinant human prourokinase 15–30 mg or urokinase 2 million IU. All had contraindications to systemic thrombolysis. We collected baseline data, procedural metrics, Miller scores (pre/post), SpO₂, hemodynamics, complications, hospital stay, and 30-day outcomes. Results The mean age of the patients was 75.8 ± 4.6 years (range 70–81 years), with five patients aged ≥70 years. One patient presented with high-risk PE (shock), and the remaining five were classified as intermediate-high risk. The mean simplified Pulmonary Embolism Severity Index (sPESI) score was 2.7 ± 1.2. The mean Miller score decreased significantly from 18.0 ± 6.7 pre-procedure to 5.2 ± 3.6 post-procedure (P < 0.05), with a mean clot clearance rate of 74.1% ± 15.2%. SpO₂ improved from 84.5% ± 5.0% pre-procedure to 97.2% ± 0.8% at 24 h post-procedure (P < 0.01). The high-risk patient was successfully weaned off vasopressors within 24 h of the procedure. No major bleeding or procedure-related deaths occurred during hospitalization. The mean hospital stay was 7.8 ± 4.4 days, and no recurrent PE or death was observed within 30 days of follow-up. Conclusion The 6F Guidezilla catheter appears safe and effective for thrombus aspiration and in situ thrombolysis in elderly PE patients who cannot receive systemic thrombolysis. It achieves good clot clearance, quick clinical recovery, and few complications. When large-bore catheters are unavailable or too risky for elderly vessels, this technique is a practical alternative.
Peng Li, Chengyu Wang, Chu Guo et al.· Frontiers in Cardiovascular...· 0 citations
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