Figure 3. A, B, C, and D: The patient returned 17 hours later as there was bleeding at the catheter site. tPA administration was stopped promptly, and the patient returned to IR for a right lower extremity venogram and further management. Improved clot burden from prior; however, there was still moderate residual clot within the proximal IVC, iliac vein extending into the mid-femoral vein (A). Angioplasty with 8 × 4 mm and 10 × 4 mm balloons was performed (B and C); however, due to residual thrombus, mechanical suction thrombectomy was performed. Post-procedural images show further improved clot burden with some minimal residual clot, and it was decided to leave the catheter in place, administering 0.5 mg tPA per hour (D).