Mechanical thrombectomy and venous-dedicated stent implantation for acute iliofemoral deep vein thrombosis with iliac vein compression.

Venous catheter intervention has been reported to promptly improve symptoms in patients with deep vein thrombosis (DVT) and may potentially prevent progression to post-thrombotic syndrome. However, the dissemination of this treatment in Japan has been limited due to the lack of dedicated devices. In December 2024, venous-specific mechanical thrombectomy and stent systems became available in Japan. We report the case of a 71-year-old man with extensive left iliofemoral DVT complicated by iliac vein compression, which was refractory to direct oral anticoagulants, catheter-directed heparin infusion and balloon angioplasty. He underwent mechanical thrombectomy using the ClotTriever® system (Inari Medical, Irvine, CA, USA), followed by deployment of a Venovo™ venous stent (BD, Franklin Lakes, NJ, USA). Following the intervention, swelling and tightness in the left lower extremity improved immediately. On postoperative day 1, the thigh and calf circumferences had decreased from 50.5 cm and 41.0 cm preoperatively to 46.0 cm and 33.0 cm, respectively. This case suggests that a novel mechanical thrombectomy system, combined with a dedicated venous stent, offers a safe and effective treatment option for refractory iliofemoral DVT without the use of thrombolytic agents. Learning objective: Transcatheter venous intervention using a novel mechanical thrombectomy system combined with dedicated venous stent implantation for extensive deep vein thrombosis with iliac vein compression is effective in restoring venous flow and alleviating symptoms without the use of thrombolytic agents, and may reduce the progression to post-thrombotic syndrome.