"Raking-in Technique:" Removal Of Brachiocephalic Vein Thrombus Using AngioVac® Device Within A Stented Venous Segment

Introduction

A case is reported of left brachiocephalic vein thrombus removal using the Angiovac device within a stented venous segment via a through-and-through access technique.

Report

This novel technique involves obtaining through-and-through access from the left basilic vein to the right femoral vein, which then facilitates the advancement of the Angiovac device to successfully remove in a stepwise fashion the thrombus present within a stented region of the left brachiocephalic vein.

Discussion

The Angiovac device has been shown to be very useful and effective at removing large amounts of thrombus, tumor, and foreign bodies within arterial and venous systems successfully. This novel technique uses the through-and-through venous access approach to allow for this device to remain close to the targeted area of thrombus burden and prevent damage of the already existing stents in this region.

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Novel technique to extract thrombus in a stented segment of vessel.

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Through-and-through access technique from the left basilica vein to the right femoral vein.

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Central venous thrombectomy using angioplasty balloon.

Role of laser atherectomy for the management of in-stent restenosis in the peripheral arteries

The prevalence of PAD is expected to increase as the population ages and the treatment for chronic disease becomes more sophisticated. The safety, efficacy, and lower cost of endovascular treatment for peripheral vascular disease of the lower extremities when compared with surgical revascularization are well known. Despite the clinical improvements and advances in endovascular techniques over the past decade, in-stent restenosis of peripheral arteries remains a challenge for the endovascular specialist. The use of excimer laser atherectomy has been shown to be safe and effective for the revascularization of complex, critical de novo peripheral lesions and offers promise in the treatment and prevention of in-stent restenosis.