Continuous Aspiration Mechanical Thrombectomy for Tissue Diagnosis of Indeterminate Inferior Vena Cava Thrombus

Purpose: To illustrate the utility of a continuous aspiration mechanical thrombectomy catheter in the tissue-proven determination and retrieval of hepatocellular carcinoma (HCC) tumor thrombus in the inferior vena cava (IVC) of a 44-year-old male patient Materials and Methods: A 44-year-old male patient presented with a week-long history of lower back pain and bilateral extremity swelling. Four-phase liver computed tomography demonstrated an ill-defined, nonenhancing 3.5-cm lesion in the IVC with indeterminate features nonspecific for bland thrombus versus tumor thrombus. The patient demonstrated multiple surgical comorbidities and was not a candidate for open surgical resection of the IVC thrombus. After right common femoral venous access, an Indigo CAT8 (Penumbra, Alameda, CA) was advanced into the IVC, and manual suction mode of a continuous aspiration mechanical thrombectomy catheter was performed to obtain tissue sample from the IVC thrombus. The patient tolerated the procedure well with no immediate complications.

Results: Pathological analysis of aspirated IVC tissue thrombus led to confirmatory diagnosis of HCC tumor thrombus.

Conclusions: To our knowledge, this is the first report of an intra-IVC biopsy using continuous aspiration mechanical thrombectomy for determination of thrombus etiology. Future studies should be performed to investigate the utility of continuous aspiration mediated thrombectomy in the diagnostic evaluation of IVC thrombus with indeterminate radiologic features in nonsurgical candidates.