Background Essential thrombocytosis (ET) is a myeloproliferative neoplasm characterized by increased platelet counts and excessive large and morphologically mature megakaryocytes in the bone marrow. ET may be complicated by thrombotic events, mostly in small and medium vessel. However there are limited evidence to guide management, particularly in cases with acute tissue ischemia. Understanding the basic pathophysiology concept of thrombosis in patient with ET is vital in choosing the right modality for revascularization. Case Summary A 73-year-old female with history of essential thrombocytosis presenting with severe debilitating pain on her right lower extremity. Physical examination showed decreased peripheral oxygen saturation. Dupplex Ultrasound revealed total thrombus at femoral artery dextra and no flow at popliteal artery, anterior and posterior tibial artery. We decided to perform revascularization with percutaneous mechanical thrombectomy (Angiojet). Arteriography evaluation still showing abundant number of thrombus. We continued with manual aspiration using guiding catheter and showing a remarkable result with normal blood flow down to the distal part with minimal residual thrombus. Discussion Histopatbological evaluations of arterial thrombi in ET revealed platelet-rich clots with abundant von Willebrand factor (VWF) and very little fibrin. Hence tllrombolysis agent used in CDT will not effective. Large thrombus which can not be lysed by fibrinolytic should be evacuated by a larger hole catheter aspiration

Background Essential thrombocytosis (ET) is a myeloproliferative neoplasm characterized by increased platelet counts and excessive large and morphologically mature megakaryocytes in the bone marrow. ET may be complicated by thrombotic events, mostly in small and medium vessel. However there are limited evidence to guide management, particularly in cases with acute tissue ischemia. Understanding the basic pathophysiology concept of thrombosis in patient with ET is vital in choosing the right modality for revascularization. Case Summary A 73-year-old female with history of essential thrombocytosis presenting with severe debilitating pain on her right lower extremity. Physical examination showed decreased peripheral oxygen saturation. Dupplex Ultrasound revealed total thrombus at femoral artery dextra and no flow at popliteal artery, anterior and posterior tibial artery. We decided to perform revascularization with percutaneous mechanical thrombectomy (Angiojet). Arteriography evaluation still showing abundant number of thrombus. We continued with manual aspiration using guiding catheter and showing a remarkable result with normal blood flow down to the distal part with minimal residual thrombus. Discussion Histopatbological evaluations of arterial thrombi in ET revealed platelet-rich clots with abundant von Willebrand factor (VWF) and very little fibrin. Hence tllrombolysis agent used in CDT will not effective. Large thrombus which can not be lysed by fibrinolytic should be evacuated by a larger hole catheter aspiration