The use of EKOS-catheter-directed thrombolysis in the management of extensive thromboembolism

This case report invites discussion on the challenges of the management of extensive thromboembolism despite standard anticoagulation.

A previously healthy 49-year-old male had an acute pulmonary embolism (PE) and was managed with rivaroxaban anticoagulation and an inferior vena cava (IVC) filter implantation. This patient re-presented with occlusion of his IVC filter with extensive thrombus extending down to his femoral veins bilaterally.

We performed catheter-directed thrombolysis using the EKOSonic Endovascular system. The patient had invasive monitoring alongside use of peri-operative cardiac imaging (TOE). A valvuloplasty balloon was used to prevent upward migration of thrombus.

There is potential for the wider use of the EKOSonic Endovascular system and catheter-directed thrombolysis in centres where there is surgical support available, and in selected patients where there is extensive thrombotic burden with risk of recurrence or long-term complications.

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