Mechanical aspiration thrombectomy before angioplasty and stenting of the left innominate vein in a patient on hemodialysis with thrombosis and occlusion of the left innominate vein

Introduction: Stenosis or occlusion of central veins associated with catheter use commonly occurs in patients on hemodialysis. Standard management includes performing angioplasty and stent placement to address these lesions, with the aim of reducing swelling in the affected upper limb and preserving the functionality of the arteriovenous fistula. However, in cases where central vein thrombosis coexists, performing these procedures carries the risk of pulmonary embolism, a potentially life-threatening complication. Objective: To describe the possibility of endovascular management of central vein thrombosis prior to angioplasty in patients with high thrombotic burden and increased risk of pulmonary thromboembolism, with the purpose of mitigating this risk. Case presentation: We present the case of a 52-year-old male patient with occlusion of the left innominate vein and a considerable thrombotic burden. Our approach consisted of mechanical aspiration thrombectomy, followed by angioplasty and stent placement in the left innominate and subclavian veins. This intervention achieved favorable angiographic and clinical results, with successful follow-up. Discussion and conclusion: The risk of pulmonary thromboembolism in patients with central vein thrombosis and high thrombotic burden has been reported in previous publications, including fatal outcomes occurring after angioplasty of these vessels. Mechanical thromboaspiration, using devices designed for this purpose, represents a strategy that significantly reduces this risk and promotes satisfactory results.