• „ Clinical vignette

Inferior vena cava thrombus after veno-arterial ECMO therapy treated with mechanical thrombectomy in an LVAD patient

Tomasz Urbanowicz1, Aleksander Araszkiewicz2, Paweł Marcinkowski1, Sylwia Sławek-Szmyt2, Bartłomiej Perek1, Maciej Walczak1, Marek Jemielity1

1Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznań, Poland

21st Cardiology Department, Poznan University of Medical Sciences, Poznań, Poland

A 53-year-old male with dilated cardiomyopathy was admitted due to heart failure deterioration that progressed to a cardiogenic shock refractory to medical therapy and intra-aortic contrapulsation.

Peripheral veno-arterial extracorporeal membrane oxygenation (v-a ECMO) was applied. During ECMO therapy, the active clotting time ranged 160–220 seconds, but the platelet count dropped from 244 to 24 109/l despite a negative result of testing for anti-PF4/Heparin antibodies.

The next day, left ventricular mechanical support (LVAD) (Heartmate 3, Abbott, Ply­mouth, MN, USA) implantation was performed through median sternotomy. Postoperatively, transthoracic echocardiography in the intensive care unit revealed a large, free-floating thrombus in the inferior vena cava (IVC) (Figure 1A). Venous access was gained through the right femoral vein. Venography showed a large thrombus in the IVC (Supp­lementary material, Video S1). The Sentrant 20 F vascular sheath (Medtronic, Minneapolis, MN, USA) was inserted and subsequently, the Indigo 8F CAT XTRQ (Penumbra, Alameda, CA, USA) catheter was placed distally to the face of the clot. Aspiration was applied to the Indigo catheter via the Penumbra Engine until CAT8 became occluded. CAT8 was subsequently removed under continuous aspiration to ensure the clot remained engaged in the catheter tip and the 11 cm long thrombus (Figure 1B) was extracted out via a large-sized vascular sheath. No complications occurred from the procedure.

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