Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: A preliminary experience

Background: Deep vein thrombosis (DVT) may be associated with significant pain, swelling and the development of post-thrombotic syndrome. Early clot removal is facilitated by the use of percutaneous mechanical thrombectomy devices. Current techniques, however, vary in rates of technical success and in some cases are limited by the concomitant need for thrombolytics. An alternative percutaneous venous thrombectomy system (ClotTriever, Inari Medical, Irvine, Calif) may be helpful in the management of lower extremity DVT without the concomitant use of thrombolytics. Methods: A retrospective review of patients treated for DVT using the device was conducted. Demographics, initial presentation, and perioperative course were recorded. Outcomes after treatment were extracted from clinical records. Technical success was defined as complete clot evacuation after intervention. Results: Twelve patients were included in the study. The cohort was 50% female (6 patients) with a mean age of 55.6 years (range, 32-86 years). Two patients (16.7%) presented with chronic asymptomatic DVT who developed symptoms from an acute, recurrent iliofemoral DVT over the days before presentation. One patient (8.4%) presented with phlegmasia cerulea dolens, with the remaining patients presenting with disabling pain and swelling. Access was obtained via the popliteal vein (11 patients) and small saphenous vein (1 patient). Lytic therapy was not used in any case. Complete clot evacuation was obtained in all patients in a single session without repeat interventions. Symptom resolution before discharge was achieved in 100% of cases. There was no incidence of postoperative anemia (mean hemoglobin, 10.7 g/dL preoperatively vs 10.4 g/dL postoperatively) or acute kidney failure (mean creatinine, 0.86 mg/dL preoperatively vs 0.81 mg/dL postoperatively). The average length of stay was 2 days (range, 1-4 days) without the need for intensive care admission. At early follow-up, 11 patients (91.7%) continued to report significant symptom resolution. Two of 10 patients (20%) developed recurrent occlusive DVTs on follow-up duplex ultrasound examination. Conclusions: This novel percutaneous venous thrombectomy system is safe and effective for removing large volumes of lower extremity acute thrombus in a single session, without the need for lytic therapy, intensive care unit admission, or repeat intervention. Further studies are warranted to determine mid-term and long-term outcomes.