Percutaneous transjugular thrombectomy in iliocaval thrombosis: Initial experience with a newly developed 12-F balloon sheath.

Purpose: To evaluate the feasibility of percutaneous thrombectomy for the r emoval of floating iliocaval thrombi using a balloon sheath. Materials and Methods: A newly developed balloon sheath (inner diameter: 12-F; outer diam eter: 18-F) was tested in two patients with extensive iliocaval thrombosis. Mechanical thrombectomy was performed due to recurrent pulmonary embolism under therapeutic anticoagulation in antiphospholipid-antibody syndrome and , respectively, paraneoplastic thrombosis without a decrease of fresh throm bus mass in spite of pharmacological treatment. Via a transjugular access ( 20-F), the sheath was advanced retrogradely into the inferior vena cava. Af ter blocking of the vessel, mechanical fragmentation was performed through the working channel coaxially, using a temporary vena cava filter as a rota ting basket (max. diameter: 30 mm). Residual thrombus fragments were remove d by aspiration. Results: The thrombectomy balloon sheath tested allowed a complete removal of fresh thrombi after fragmentation. In addition, older c lot material was obtained. Balloon occlusion prevented the central emboliza tion of thrombus fragments. Clinical signs indicating pulmonary embolism we re not seen. The fluid loss due to aspiration was negligible. Conclusions: The newly developed 12-F balloon sheath proved to be efficient for the extr action of large thrombi. Balloon occlusion safely prevented central emboliz ation of thrombus fragments proximal to the sheath.