Abstract No. 476 Portal vein recanalization using Inari FlowTriever system: a single-center experience

Inari FlowTriever thrombectomy system is intended for use in the peripheral vasculature and pulmonary arteries, with published off label use in the inferior vena cava (1). This case series evaluates the use of the FlowTriever system for portal vein thrombectomy at a single institution during or remotely after transjugular intrahepatic portosystemic shunt (TIPS) placement. 6 patients (mean age, 55.3 years) for whom the FlowTriever system was used for portomesenteric vein thrombectomy between October 2019 and September 2020 were retrospectively evaluated. All patients had underlying cirrhosis complicated by portal hypertension with symptomatic acute/subacute portomesenteric vein thrombus. FlowTriever thrombectomy was performed either in tandem with primary TIPS placement in 3 patients, or via a previously placed thrombosed TIPS in 3 patients. For the latter, mean time interval between TIPS and thrombectomy was four years. In 3 patients, Gore Viatorr stents with controlled expansion (CX) were placed. Viatorr stents without controlled expansion were used in the 3 other patients. In all cases, thrombectomy was technically successful with resolution of symptomatic clot burden in a single session without fibrinolysis. All cases required more than 2 passes with the thrombectomy system. No intra-procedural adverse events were encountered, including TIPS displacement. All patients showed TIPS/portomesenteric patency on follow-up imaging without TIPS migration. Mean follow-up time was 107 days (range, 5–264 days). Inari FlowTriever thrombectomy system is safe and effective for portomesenteric venous recanalization in TIPS patients, including at primary TIPS placement.