Popliteal Access in the Supine Position for Endovenous Management of Deep Vein Thrombosis

The preferred venous access site for percutaneous management of deep venous thrombosis (DVT) is the popliteal vein, with the patient in the prone position. Owing to the need for additional venous access, including the jugular or femoral veins, popliteal access in the prone position requires supine repositioning of the patient. A technique for puncturing the popliteal vein in the supine position is proposed, which allows for additional venous access in the same position in patients with DVT.

Ultrasound guided popliteal vein access was obtained in the supine position and then pharmacomechanical thrombectomy and iliocaval stent placement was performed for the management of DVT when indicated.

Eight patients were included (four men, four women; mean ± standard deviation age of 44.2 ± 14.1 years). Popliteal access was performed successfully in the supine position in all patients. An inferior vena cava filter was inserted in five patients and stents were placed in four. Complete recanalisation of occluded vein segments was obtained successfully with popliteal access in supine position in all patients. None of the patients had early or late complications, including arterial puncture, bleeding, haematoma, or neurological disorder. Veins and stents were patent on duplex ultrasound in all seven patients reaching the six month follow up. One patient with patent veins and stents has not yet reached the six month follow up. The technique of popliteal vein access in the supine position for percutaneous endovenous interventions appears to provide a reliable alternative to access in the prone position.