Ultrasound guided full mechanical thrombectomy of a floating thrombus in the common femoral vein

Submitted: 8 December 2023
Accepted: 25 December 2023
Published: 29 December 2023
Abstract Views: 290
PDF: 18
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


A Floating Venous Thrombus (FVT) in the deep venous system has a high potential to cause pulmonary embolization. There are no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. Catheter-directed thrombolysis is effective for treatment of venous clots, but it is associated with increased risk of bleeding. Mechanical thrombectomy currently represents a valid therapeutic option without the need for lytic therapy and with excellent short and medium-term results. We herein present a technical note through an explicative case of a patient with an FVT located in the left common femoral vein who underwent to percutaneous venous mechanical thrombectomy (ClotTriever, Inari Medical, Irvine, CA, USA) under ultrasound guidance without an intravascular ultrasound check. At the end of the treatment, venography and duplex ultrasound scan showed ilio-femoral patency without residual thrombus. No further procedures were needed and the patient was discharged two days post-intervention with oral anticoagulation and compression therapy with stockings.

Sada A, Habermann EB, Dy BM, et al. Incidence of venous thromboembolism following adrenalectomy: A CESQIP analysis. Am J Surg. 2023:S0002-9610(23)00529-9. DOI: https://doi.org/10.1016/j.amjsurg.2023.10.022

Jorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of lower limbs. J Vasc Surg. 1993;18:70-3. DOI: https://doi.org/10.1067/mva.1993.42072

Baldridge ED, Welling RE, Martin MA. Clinical significance of free-floating venous thrombi. J Vasc Surg. 1990;11:62-7. DOI: https://doi.org/10.1067/mva.1990.15991

Notten P, de Smet AAEA, Tick LW, et al. CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis on Preventing Post-Thrombotic Syndrome) Trial: Long-Term Follow-Up Results. J Am Heart Assoc. 2021;10:e018973. DOI: https://doi.org/10.1161/JAHA.120.018973

Enden T, Haig Y, Kløw NE, Slagsvold CE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;379:31-8. DOI: https://doi.org/10.1016/S0140-6736(11)61753-4

Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46:1571-80. DOI: https://doi.org/10.1007/s00270-023-03509-8

Voet D, Afschrift M. Floating thrombi: diagnosis and follow-up by duplex ultrasound. Br J Radiol. 1991;64:1010-4. DOI: https://doi.org/10.1259/0007-1285-64-767-1010

Casian D, Gutsu E, Culiuc V. Extraluminal venous interruption for free-floating thrombus in the deep veins of lower limbs. Chirurgia. 2010;105:361-4.

Dexter D, Kado H, Shaikh A, et al. Safety and Effectiveness of Mechanical Thrombectomy From the Fully Enrolled Multicenter, Prospective CLOUT Registry. JSCAI. 2023;2:100585. DOI: https://doi.org/10.1016/j.jscai.2023.100585

Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2016;11:CD002783. DOI: https://doi.org/10.1002/14651858.CD002783.pub4

Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377:2240-52. DOI: https://doi.org/10.1056/NEJMoa1615066

Sato S, Iwai T, Sakurazawa K, et al. Conservative treatment of acute deep vein thrombosis of lower extremities. Nihon Geka Gakkai Zasshi. 1992;93:1052-4.

Baccellieri, D., Ardita, V., & Tinaglia, S. (2023). Ultrasound guided full mechanical thrombectomy of a floating thrombus in the common femoral vein. Veins and Lymphatics, 12(1). https://doi.org/10.4081/vl.2023.12169


Download data is not yet available.