Thrombolysis Through Punctured Coronary Balloon and 014 wire mediated guitaring after IVC filter insertion in Ilio-femoral Deep Vein Thrombosis

Abstract

Background/AimsDeep vein thrombosis (DVT) is common in clinical practice and it is associated with systemic illnesses and frequently associated with complications. The classic presentation is unilateral limb oedema associated with pain. Acute pulmonary embolism is common which is life threatening. Long-term complications like post thrombotic syndrome, recurrent deep vein thrombosis, chronic venous ulcers and cellulitis are common and debilitating. There are many treatment pharmaco-mechanical and pharmaco-invasive treatment methods in DVT. This is a case report of a patient who presented with iliofemoral deep vein thrombosis, and was treated with pharmaco-invasive and pharmaco-mechanic methods using coronary balloon and mechanical disruption of clots with coronary 014 wire using the guitaring technique.Case presentationA 65-year male presented with acute deep vein thrombosis extending from left common iliac to the popliteal vein. The patient had significant swelling and pain in the left lower limb. IVC filter was inserted, and catheter-directed thrombolysis was planned. The technical difficulty was encountered entering the proximal common iliac vein. Hence, a 014 BMW wire with coronary balloon support was introduced through Cordis 6F diagnostic catheter, and the 014 wire was advanced with guitaring technique up to the femoral vein. Thereafter, the coronary balloon was ruptured at high pressure, and thrombolysis using streptokinase was performed along the balloon tract till the ostium of the common iliac vein. The patient symptomatically improved significantly and is currently on anticoagulants. Follow-up after one year showed minimal residual oedema, and pain in the ankle region.Conclusion Deep vein thrombosis is a common disease associated with life-threatening and chronic complications. In iliofemoral thrombosis with significant symptoms, pharmaco-invasive treatment by catheter-directed thrombolysis is beneficial. If the difficulty is encountered crossing the proximal iliac vein obstructions crossing the lesion with 014 wire and coronary balloon support is a helpful technique which was used in this case. Pharmaco-mechanical treatment is possible using coronary balloon dilatations and thrombolysis through a ruptured coronary balloon. Mechanical disruption of clots to some extent is feasible using 014 wire by guitaring technique.