Intravascular ultrasound–guided thrombus aspiration for acute iliac vein thrombosis

A 68-year-old man presented with acute onset swelling of the right lower extremity lasting 24 hours. Duplex ultrasonography demonstrated extensive thrombus formation within the right iliac vein, accompanied by a markedly elevated D-dimer level. Given the high thrombus burden and the limitations of conventional venography in defining intraluminal pathology, intravascular ultrasound (Boston Scientific Corporation) was employed with femoral vein access for catheter insertion and thrombus aspiration. Written informed consent for publication of clinical data and images was obtained from the patient.

Pre-interventional IVUS imaging provided direct visualization of a large, occlusive thrombus within the right iliac vein, precisely delineating its longitudinal extent and luminal involvement (A, Supplementary Video 1, online only). Based on IVUS findings, catheter-directed thrombus aspiration was performed using a 14F aspiration catheter (Rhinoceros, Kossel) under continuous IVUS guidance (B). Real-time intravascular imaging enabled accurate catheter positioning, dynamic assessment of thrombus engagement, and immediate evaluation of thrombus reduction during aspiration (C).

Following completion of aspiration, IVUS confirmed near-complete thrombus clearance with restoration of luminal patency and unimpeded venous flow (D, Supplementary Video 2, online only), findings that were less apparent on contrast venography alone. This case illustrates the utility of IVUS as a real-time intraprocedural imaging modality to overcome visualization limitations inherent to fluoroscopy-based assessment, enabling precise thrombus localization, guidance of aspiration strategy, and objective confirmation of procedural endpoints in acute iliac vein thrombosis.

Funding

None.

Disclosures

None.