Protrieve Sheath for Embolic Protection in Percutaneous Thrombectomy: A Systematic Review

Venous thromboembolism is a recognized adverse event of percutaneous venous thrombectomy. The Protrieve Sheath (Inari Medical; Irvine, CA) is Food and Drug Administration (FDA)-approved as a large-bore venous sheath designed for intraprocedural embolic protection, but evidence supporting its efficacy remains limited. This study aimed to evaluate the efficacy of the Protrieve Sheath for embolic protection during percutaneous venous thrombectomy.

This systematic review of literature investigated the use of the Protrieve Sheath as a venous embolic protection modality. Eligible studies were screened by 2 independent reviewers using predefined inclusion and exclusion criteria, and 12 were included in the final systematic review. Data extracted included patient demographics, venous segments treated, procedural indications, and intraprocedural embolic events or adverse events. Study quality was assessed using the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool.

A total of 93 patients were included in this systematic review. Thrombus location was primarily inferior vena cava (IVC) or lower extremity vasculature (95.7%), and 4.3% involved the superior vena cava (SVC) or upper extremity vasculature. Mechanical thrombectomy was performed in all cases, although additional reported interventions included IVC filter removal (23 cases, 5 studies) and venous angioplasty (27 cases, 4 studies). The Protrieve funnel was typically deployed suprarenally, with one infrarenal case reported. Most articles did not report any significant embolic or adverse events.

The Protrieve Sheath appears safe and effective for embolic protection during percutaneous thrombectomy, with no significant periprocedural events reported.