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Early Experience Using Venous Sheath With Embolic Protection During Thrombectomy of Inferior Vena Cava and Complex

Mennatalla Hegazi1, Peter D Nguyen1, Nii-Kabu Kabutey2

  • 1Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA.

The American Surgeon
|May 17, 2025
PubMed

Insights

The Inari Protrieve sheath may reduce pulmonary embolism risk during inferior vena cava thrombectomy. Securing the sheath is recommended to prevent migration and maintain embolic protection.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Percutaneous thrombectomy for inferior vena cava (IVC) and iliocaval lesions carries a risk of thromboembolism.
  • The Inari Protrieve sheath, featuring a 33.5 mm funnel, is designed to provide embolic protection during thrombectomy, potentially reducing pulmonary embolism (PE) risk.

Purpose of the Study:

  • To evaluate the safety and efficacy of the Inari Protrieve sheath as an embolic protection device during percutaneous thrombectomy for acute IVC and iliocaval deep vein thrombosis (DVT).
  • To assess the incidence of postoperative embolic events, technical success rates, perioperative complications, and long-term patency.

Main Methods:

  • Retrospective review of 13 adult patients undergoing mechanical thrombectomy with the Inari Protrieve sheath between September 2022 and September 2023.
  • Procedures involved deployment of the Protrieve sheath via the right internal jugular vein, followed by thrombectomy using ClotTriever or FlowTriever devices.
  • Outcomes included postoperative embolic events, technical success, complications, and 3- and 6-month patency rates.

Main Results:

  • All 13 patients achieved technical success in thrombectomy.
  • Two patients (15.4%) experienced in-hospital subsegmental PE, both associated with intraoperative sheath manipulation.
  • Three-month and six-month patency rates were 75.0% and 71.4%, respectively. Five patients required venous stenting.

Conclusions:

  • The Inari Protrieve sheath demonstrates potential in mitigating PE risk during IVC thrombectomy.
  • Periprocedural sheath migration, due to its hydrophilic coating, can compromise embolic protection, necessitating secure fixation at the skin insertion site.
  • Recommendations include securing the sheath to prevent migration and ensure continuous embolic protection.

Keywords:
ClotTrieverFlowTrieverInariProtrieveembolic protection deviceinferior vena cava filterpulmonary embolism

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