Novel Use of the RevCore^TM Device in Extensive Subacute Iliocaval Thrombus

A 49-year-old female presented with subacute onset of severe worsening bilateral lower extremity swelling. Bilateral iliac venous thrombus and extensive thrombus of the inferior vena cava with extension to the right atrium and bilateral segmental pulmonary emboli was identified on imaging. She was initiated on therapeutic anticoagulation prior to undergoing percutaneous mechanical thrombectomy with the RevCore TM device (Inari Medical, Irvine, CA) with retrieval of white, relatively well-formed organized clot vs mass. Intravascular ultrasound and venography showed significant improvement in the IVC and iliac vein patency, but some narrowing of the vena cava. The patient's course was complicated by hypotension and acidemia requiring extracorporeal membrane oxygenation for seventy-two hours. She was taken back during her hospitalization for additional venogram and intravascular ultrasound with long segment IVC stenting of the IVC stenosis. She was ultimately discharged with significant clinical improvement. While the nitinol coring element on this device is meant for use in venous stent thrombus, this case demonstrates additional uses for the RevCoreTM device in organized thrombus in the native system in selective patients.