Visceral aortic thrombectomy using endovascular technique

A 58-year-old male in cardiogenic shock requiring a left ventricular assist device and veno-arterial extracorporeal membrane oxygenation with worsening lactic acidosis was found to have acute occlusion of the visceral aorta, celiac axis, superior mesenteric artery (SMA), and left renal artery. We describe the off-label use of the Inari ProTrieve Sheath to prevent distal thromboembolic events during mechanical aortic thrombectomy in a patient on extracorporeal membrane oxygenation who could not tolerate aortic cross-clamping. Retrograde SMA thrombectomy and patch angioplasty was subsequently performed, followed by temporary abdominal closure. The patient's lactic acidosis improved significantly, and repeat imaging revealed a patent aorta and SMA.