This study clearly depicts that Patients with large-volume iliocaval deep venous thromboses (DVTs) for whom there are contraindications to chemical thrombolysis pose unique treatment challenges. We sought to evaluate our updated single-center experience with percutaneous suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) device for this distinct subset of patients. During a 5-year period, patients with large-volume iliac vein or vena cava DVTs and a contraindication to chemical thrombolysis were evaluated for suction thrombectomy with the AngioVac device. Perioperative patient variables and clinical outcomes were evaluated to determine the clinical efficacy. Thirty-one patients with large-volume iliocaval DVTs were evaluated, and 15 patients were deemed unsuitable because of high surgical risk secondary to comorbid conditions (6), bacteremia (2), bleeding complications (2), inability to tolerate therapeutic anticoagulation (2), or thrombosis due to external mass effect (3). Seventeen patients (7 male, 10 female; mean age, 53 years; body mass index, 33 kg/m2) with contraindications to chemical thrombolysis (7 relative, 10 absolute) were offered treatment. Preoperative demographics demonstrated that 14 (82%) had a concomitant lower extremity DVT, 7 (41%) also had a pulmonary embolism, and 3 (18%) had thrombus extension into the right atrium. Intraoperatively, 12 (70%) patients required adjunct mechanical thrombolysis, and 10 (59%) had a temporary inferior vena cava filter placed during the procedure.

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