Angioscopic Findings of Deep Vein Thrombosis Treated by Balloon Angioplasty With Catheter-Directed Thrombolysis

A 43-year-old woman developed left lower limb swelling after undergoing cesarean section. Contrast-enhanced computed tomography (CT) showed deep vein thrombosis (DVT) from left common iliac vein (CIV) to the vein below the knee (Figure A). Intravenous heparin therapy was not effective. We performed balloon angioplasty and catheter-directed thrombolysis (CDT) with angioscopy (Zemporshe^® and Forwardlooking^®, OVALIS, Osaka, Japan) (Figure B). Her symptoms improved after receiving CDT for 5 days; there were no apparent fresh residual red thrombi in the left CIV (Figure C–E). However, she developed recurrence of left lower limb swelling 1 month later, despite receiving direct oral anticoagulants. CT and venography showed narrowing of the left CIV and DVT in the left popliteal vein (Figure F,G). Angioscopy revealed “slit” and “mesh” appearance in the left CIV (Figure H).

Figure.

Computed tomography (CT) at admission (A) Angioscopy of the left common iliac vein (CIV). Yellow arrows indicate the thrombus. (B) CT after balloon angioplasty and catheter-directed thrombolysis. (C) Venography after balloon angioplasty and catheter-directed thrombolysis. (D) Angioscopic findings indicated by the arrow in (C,D). No apparent fresh residual red thrombus is seen by angioscopy. (E) CT performed at re-admission. (F) Venography performed at re-admission. (G) Angioscopic findings indicated by the arrow in (F,G). “Slit” and “mesh” appearance is seen by angioscopy.

Organized thrombus (“mesh” and “slit” appearance) is often observed on angioscopy of pulmonary arteries in the setting of chronic thromboembolic pulmonary hypertension (CTEPH).¹ In the present case, the organized thrombus in veins was similar to that in the pulmonary arteries in the setting of CTEPH, and developed over a short period (1 month).

Disclosure

T.M. is a member of Circulation Journal’ Editorial Team. The other authors have no conflicts of interest to declare.

IRB Information

The local ethics committee of Niigata University School of Medical and Dental Sciences determined ethics approval for a case report was unnecessary.

Reference

• 1.   Takano T, Ozaki K, Hoyano M, Yanagawa T, Kashimura T, Minamino T. Angioscopic findings during balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Cardiovasc Interv Ther 2020; 35: 421–422.