Penumbra indigo device thrombectomy in thrombosed SVC and left brachiocephalic vein

Abdulrahman Al Qahtani, Qazi Shahbaz, Mohammed Al-Aftan, Aljabriyah Al-FutaisDepartment of Medical Imaging, King Abdul Aziz Medical City, Riyadh, Kingdom of Saudi Arabia

28 year old male k\c of rectal cancer. Post sigmoid loop colostomy 2016 and Chemoradiotherapy Portacath inserted in January 2018 In 2019, aborted abdominopelvic resection due to frozen pelvis. Day 5 post OP, Severe facial swelling and upper arms swelling. SVC syndrome. On heparin infusion, not responded.

Endovascular treatment

Imaging

➢IMAGING

References

➢ Immediate response clinically, with resolved facial swelling on next day, discharged two days later with low dose prophylactic anticoagulation for 3 months

Result

Left brachial vein access, 9Fr sheath was inserted. Angiogram showed thromboses left subclavian vein, left brachiocephalic vein and SVC The wire successfully crossed the thrombosis, 6mg t-PA was infused within the thrombosed veins. 10 minutes later, 8Fr penumbra indigo system was inserted, 80% of thrombus was aspired with Pneumbra.

CT scan showed left brachiocephalic and SVC thrombosis

➢After the initial aspiration thrombectomy, small residual thrombosis is still identified. Which was macerated with 14 mm balloon angioplasty.

Case presentation

ENDOVASCULAR TREATEMENT

Conclusion➢Penumbra indigo device showed an effective

response for acute thrombosis in critical location.

SAAB, F., PARK, J. H., VADLAMUDI, V., FAKHIR ELMASRI, M. D., & EZELL ASKEW JR, M. D. Indigo® System for Thromboembolic Disease.