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Addressing Infra-popliteal Thrombus in Iliofemoral DVT: The Criss-Cross Technique

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Abstract

Purpose

The purpose of this work was to describe the results of a technique of simultaneous antegrade and retrograde vascular access (“criss-cross”) to the popliteal vein to achieve venous recanalization in patients with acute, extensive, iliofemoral DVT with concomitant popliteal and calf vein thrombosis.

Materials and Methods

Seven patients were treated using this technique, in three patients as a bailout option after failed posterior tibial vein puncture and in four as a first option. Antegrade popliteal venous access was performed according to the usual technique using duplex ultrasound (DUS) guidance and thrombolysis (CDT), or thrombectomy (PMT) was performed. Following this, the retrograde sheath was placed under DUS guidance, a tibial vein was selectively catheterized and CDT, and/or a PMT was performed.

Results

Three patients underwent isolated CDT, another three had associated PMT, and one patient underwent iliofemoral PMT and catheter thromboaspiration of the popliteal and calf veins. Median thrombolysis duration was 72 h (24–72 h). SIR grade III thrombolysis was achieved in six patients and grade II in one patient. All patients underwent subsequent stenting of their iliac vein lesions. Minor complications were observed in two patients (ecchymosis), while one patient developed a hematoma on the popliteal fossa.

Conclusion

This “criss-cross” technique represents a safe alternative to the distal (anterior or posterior tibial) vein access both as a bailout option after failed distal venous access as well as a primary approach due to its potential advantage of clearing larger thrombus volume. Experience in ultrasound-guided popliteal vein puncture is crucial to avoid complications.

Level of Evidence

Case series, Level IV.

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Acknowledgements

We thank Dr. Carolina Mateus, from the Anesthesiology Department, Centro Hospitalar do Porto, for providing the ultrasound images and for the help with its neuroanatomical interpretation.

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Authors and Affiliations

  1. Department of Angiology and Vascular Surgery, Centro Hospitalar do Porto – Hospital de Sto. António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal

    Duarte C. Rego

  2. Vascular and Endovascular Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt

    Ahmed Khairy Sayed Ahmed

  3. Department of Interventional Radiology, University College Hospital of Galway, National University of Ireland, Galway, Ireland

    Gerard J. O’Sullivan

Authors
  1. Duarte C. Rego
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  2. Ahmed Khairy Sayed Ahmed
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  3. Gerard J. O’Sullivan
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Corresponding author

Correspondence to Duarte C. Rego.

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Conflict of interest

Co-author Gerard J. O’Sullivan is a speaker for the following companies: BSCI, Medtronic, Bard, Marvao and Straub. The other authors declare that they have no conflict of interest.

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Rego, D.C., Ahmed, A.K.S. & O’Sullivan, G.J. Addressing Infra-popliteal Thrombus in Iliofemoral DVT: The Criss-Cross Technique. Cardiovasc Intervent Radiol 41, 1095–1099 (2018). https://doi.org/10.1007/s00270-018-1918-z

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  • DOI: https://doi.org/10.1007/s00270-018-1918-z

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