132 - Simplifying Complex DVT Thrombectomy Using the Protrieve Sheath: A Retrospective Analysis of the Largest Patient Series to Date

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Akash Nijhawan, MD

Medical Student
FIU Herbert Wertheim College of Medicine, United States

Author/Co-author(s)

Rafey Khan, BS (he/him/his)

Medical Student
FIU HWCOM, United States
Alex Powell, MD, FSIR

Attending Physician
MCVI, United States
Govindarajan Narayanan, MD, FSIR

Professor and Interventional Radiologist
Miami Cardiac & Vascular Institute, United States
Constantino Pena, MD

Clinical Associate Professor Radiology
Florida International Universirty and University of South Florida , United States
Brian J. Schiro, MD

Vascular and Interventional Radiologist
Miami Cardiac & Vascular Institute / Radiology Associates of South Florida, United States
Ripal Gandhi, MD, FSIR

Interventional Radiologist
Miami Cardiac & Vascular Institute, Miami Cancer Institute, United States

Purpose: Endovascular treatment of complex deep vein thrombosis (DVT) is associated with an increased risk of procedural thrombus embolization and subsequently iatrogenic pulmonary embolism (PE). The Protrieve sheath (Inari Medical, Irvine, CA) is an aspiration-capable introducer sheath that is deployed in the inferior vena cava (IVC) through the right internal jugular vein access. For the first time, we evaluated the safety and feasibility of the device in capturing intraprocedural emboli during intervention for complex DVT, including thrombosed stents and IVC filters.

Materials and Methods: This single center retrospective analysis from October 2022 to August 2024 evaluated patients who underwent a complex DVT thrombectomy or IVC filter retrieval procedure that involved the use of the study device. Baseline and procedural characteristics including emboli captured in the study device were collected. Postprocedural patency and procedure-related serious adverse events, namely mortality, clinically significant PE, major bleeding (requiring blood transfusion of >3 units of whole blood or packed red blood cells), access site complications, ICU stay, and readmission were assessed.

Results:

Of 21 patients, the mean age was 61.8 years and 71% were female. The study device was used during IVC filter retrieval (43%) and/or thrombectomy (76%) procedures, as summarized in Table. Embolized thrombus was observed in the device funnel in 90% of cases. Complete patency was achieved in 88% of patients. Mortality, major bleeding, or access site complications rates were 0%. Three (14%) patients exhibited symptoms of PE: 2 tachycardic and 1 hypotensive. CT angiography confirmed PE diagnosis in the 2 tachycardic patients (both PEs were small and segmental), however, the procedure-relatedness remained inconclusive. In one patient, there was no pre-procedure CT pulmonary angiogram, making it impossible to determine if the PE was preexisting. Procedure-related ICU stay was 0, and procedure-related readmission rate was 0%.

Conclusion: In our experience, utilization of the study device in our complex DVT intervention enhanced the safety and success of procedures with increased risk of intraprocedural embolization.