A Guitaring Technique with 035 Wire and Perforated Coronary Balloon for Thrombolysis in the Treatment of Acute Deep Vein Thrombosis

A patient who underwent thrombolysis and inferior vena cava filter implantation for acute deep vein thrombosis treatment nine years before, presented with deep vein thrombosis on the other limb. The venous angiogram showed deep vein thrombosis in the ilio-femoral vessels. Through left femoral vein puncture, a 6F right Judkins diagnostic catheter was advanced up to the proximal iliac veins, and further advancement was not possible. Hence, a 035 hydrophilic wire was advanced, and through a guitaring technique, the clots were disrupted at the mid-thigh level. Through a 014 coronary wire, a punctured coronary balloon was placed at the distal mid-thigh level, and intravascular thrombolysis was performed for 12 hours, followed by removal of the balloon and the right coronary Judkins catheters. The leg swelling reduced in the first day, and subsequently, the patient was followed up for 7 months with anticoagulation and good resolution of the symptoms.