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We report a case of acute gouty monoarthritis of the left ankle in a 58-year-old female with chronic renal insufficiency after cryoablation of a 3.8 cm left renal cell carcinoma. The patient's symptoms resolved after intravenous Solumedrol and did not recur at her 1-month follow-up visit. To the best of our knowledge, this is the first reported case of acute gouty monoarthritis after cryoablation of a renal cell carcinoma lesion in a patient with underlying chronic renal insufficiency. Clinicians should be vigilant of the potential for this complication in at-risk patient populations.

Objectives: This report evaluates the safety of percutaneous mechanical thrombectomy with the Inari FlowTriever System (Inari Medical, Irvine, California) for the treatment of acute massive/submassive pulmonary embolism (PE) specifically in therapeutically anticoagulated patients with contraindication to thrombolysis. Material and Methods: A single-center retrospective chart review was performed on patients with contraindication to thrombolysis and massive/submassive PE who underwent FlowTriever thrombectomy between 2017 and 2019. Primary outcomes included procedure or device-related complications within 30 days of discharge. Secondary outcomes included technical and clinical success defined by improvement in mean pulmonary artery pressure (PAP), oxygen saturation, and heart rate. Results: Thirteen patients with contraindication to thrombolysis received FlowTriever thrombectomy with technical success achieved in all cases. Zero major or minor adverse events, technical complications, delayed procedure-related complications, or deaths within 30 days of hospital discharge occurred. Mean PAP decreased significantly by 19.1% (32.5 ± 13.3 mmHg to 26.3 ± 12.4 mmHg; P = 0.0074, 95% confidence interval (CI) 2.0–10.5 mmHg). Oxygen saturation improved post-procedure (increased 3.9 ± 3.8%; p = 0.0032, 95% CI 1.6– 6.1%) as did heart rate (decreased 22.2 ± 17.0 bpm; P < 0.001, 95% CI 11.9–32.4 bpm). Anticoagulation was maintained throughout every procedure and all patients were closed with purse-string suture only. Conclusion: FlowTriever mechanical thrombectomy appears safe for acute PE in therapeutically anticoagulated patients with contraindications to thrombolytic therapy. These patients may experience immediate hemodynamic improvements similar to those reported in other studies. Further data are needed to prospectively evaluate long-term safety in this population.

Background: Inferior vena cava (IVC) filter retrieval is typically accomplished with a standard loop snare. When this fails, more advanced techniques are necessary, especially when removal falls outside a 12-month window. Complications during filter retrieval depend heavily on technique, type of filter, and filter position. In this study we examined safety and efficacy of 536 filter retrievals at a tertiary care center and compared complication rates between standard loop snare and endobronchial forcep retrieval. Method: We reviewed 536 cases between August 2015 and August 2020, recording retrieval success rates, patient comorbidities, and complication rates at the time of removal. Results: Total overall retrieval success was 97.9% (525/536), and complications occurred in approximately 6.0% (32/536) of all cases. Success and complications with standard snare technique alone were 99.4% (345/347) and 1.7% (5 Grade I/II, 1 Grade III) and advanced forcep technique 98.8% (171/173) and 14.5% (22 Grade I/II, 2 Grade III, and 1 Grade IV), respectively. There was no significant difference between the technical success rates of the isolated loop snare and forceps techniques (p=0.60) despite a significantly longer dwell time in patients undergoing forceps retrieval ( p<0.001). Conclusion: To our knowledge, this is the largest cohort of forceps directed IVC filter retrieval present in the literature. Successful endobronchial forceps and loop-snare retrieval rates in this study are similar to previous reports. Although use of endobronchial forceps may be associated with higher complication rates, this is likely due to prolonged dwell times, filter tilt, and attempted removal of non retrievable filters. Overall, forceps-directed retrieval offers a safe, effective means of removal in difficult cases. Level of Evidence: Level 3, Large Retrospective Study