Patients scheduled for a venous thrombectomy procedure often find it reassuring to know exactly what will happen, in what order. While specifics vary by clot location and the device used, most procedures follow a similar sequence of steps from initial preparation through final imaging confirmation. This walkthrough outlines that typical sequence.
Step One: Preparation and Vascular Access
The procedure begins with the patient positioned on the imaging table, and the treatment area is cleaned and draped in sterile fashion. Local anesthesia is applied at the planned entry point, most often a vein in the leg, and the interventionalist obtains venous access using a needle and guidewire technique, followed by placement of an introducer sheath to allow catheters to be exchanged safely throughout the case.
Step Two: Initial Venography to Map the Clot
Once access is established, contrast dye is injected and X-ray imaging (venography) is used to visualize the full extent of the thrombus, including its location, length, and any areas of underlying narrowing. This mapping step guides the interventionalist's plan for how to approach the clot and which segments will require the most attention.
Step Three: Advancing the Thrombectomy Device
A guidewire is advanced through the clotted segment under fluoroscopic guidance, and the thrombectomy catheter is then tracked over this wire to the target area. Depending on the device and clot characteristics, the interventionalist may use rotational fragmentation, aspiration, or a combination of both to engage and remove the thrombus, often making multiple passes along the affected segment.
Step Four: Clot Removal and Reassessment
As clot is fragmented and aspirated, the interventionalist periodically pauses to reassess the vessel with contrast injections, checking how much clot remains and whether flow is improving. This iterative process continues until an acceptable degree of clearance is achieved, balancing thoroughness against procedure time and vessel trauma.
Step Five: Evaluating for Underlying Causes
If imaging suggests an anatomical contributor to the clot, such as iliac vein compression, the interventionalist may use intravascular ultrasound (IVUS) or additional venography to evaluate the finding more closely. Depending on what is found, a venous stent may be placed within the same session to address the underlying narrowing.
Step Six: Completion Venography and Closure
Before finishing, a final venogram — completion venography — is performed to confirm that blood flow through the treated segment has been restored and that no significant residual clot remains. The catheters and sheath are then removed, manual pressure or a closure device is applied to the access site, and the patient is moved to a recovery area for monitoring.
INVAMED Devices Used in This Workflow
Catheter-based thrombectomy systems designed for this type of procedure include INVAMED's Mantis PRO Rotational Thrombectomy and Ultra Aspiration system, which combines rotational fragmentation with an integrated aspiration lumen for deep venous occlusions; details are available on the Mantis PRO product page. The specific device and technique used in any given case are selected by the treating interventionalist.
What happens if a stent is needed during the same procedure?
If an underlying obstruction is identified, a venous stent may be deployed in the same session immediately after clot removal, extending procedure time somewhat but potentially avoiding the need for a separate future intervention.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.