Large-bore Thrombectomy for Iliocaval Thrombosis: An Updated Device Review

Large-bore thrombectomy has emerged as a critical treatment option in the management of iliocaval thrombosis, a condition associated with high morbidity and mortality. These devices are designed for rapid removal of clot and symptom resolution while minimizing the need for thrombolytic therapy. Ongoing trials, prospective registries, and retrospective reviews are also investigating the role of early thrombectomy or thrombolysis on subsequent development of post-thrombotic syndrome. These interventions are particularly beneficial for patients with contraindications to systemic or catheter-directed thrombolysis, those at high risk for post-thrombotic syndrome, or those with chronic thrombus, which is less likely to respond to lytic therapy. These devices utilize mechanical, aspiration, and rotatory systems to break up and remove acute and chronic, densely adherent thrombus. Each has unique characteristics that make them preferred in different disease states and many cases require use of multiple devices in conjunction with one another. This review describes the importance of large-bore thrombectomy in the treatment of iliocaval thromboembolic disease and highlights modern devices and case-specific uses for each.