Chronic Left External Iliac and Common Iliac Vein Stent Occlusion After Iliocaval Reconstruction Treatment with RevCore Thrombectomy System

Percutaneous access was obtained for the right internal jugular (RIJ) vein and bilateral common femoral veins (CFV). CT venography confirmed complete occlusion of the left EIV and CIV stents. A 16-F sheath was introduced through the left CFV access, and the stent occlusions were crossed using a Glidewire and Glidecath catheter. Intravascular ultrasound (IVUS) was used to interrogate stent damage and confirm wire position in the true lumen. Serial dilatation to 20F was performed on the RIJ access, followed by insertion and advancement of a Protrieve sheath to the intrahepatic inferior vena cava. After confirmation of full wall apposition with IVUS, the RevCore System (Inari Medical, USA) was introduced and advanced to the left EIV and CIV stents. Three passes were performed from the RIJ access and five passes from the left CFV access, achieving significant removal of collagenous thrombus from the stents. Aspiration thrombectomy was performed through the Protrieve sheath with a Triever16 catheter and minimal residual material within the stent lumen was observed with IVUS. Next, venoplasty was performed with a 14x60-mm Atlas ultra-noncompliant PTA balloon (BD Interventional, USA). Completion venogram confirmed full patency and brisk flow through the previously occluded stents. The patient was discharged on postoperative day 1. At 1-month follow-up, the patient referred complete swelling resolution, and CT venography revealed widely patent bilateral iliac vein stents (Figure 1C-H).

Conclusions: The RevCore system is a feasible alternative for treatment of chronic IST.  This device has potential for improvement of long-term patency and quality of life and may be an adjuvant intervention for PTS patients with failed venous stent procedures.