Objective: The efficacy of routine inferior vena cava (IVC) filter placement during catheterdirected thrombolysis (CDT) or pharmacomechanical thrombectomy (PMT) for iliofemoral deep vein thrombosis (IF-DVT) remains controversial. This study aimed to evaluate whether routine IVC filter placement improves prevention of pulmonary thromboembolism (PTE) or recurrent venous thromboembolism (VTE) in this population. Methods: We retrospectively reviewed adults with acute IF-DVT treated with CDT/PMT (March 2021–February 2025) and compared outcomes between a filter group (n=17) and no-filter group (n=21). All patients received six months of oral anticoagulation. The primary outcome was incident PTE within six months. Secondary endpoints included the 6-month composite of recurrent VTE (recurrent deep vein thrombosis and/or PTE), inferior vena cava thrombosis, and target-limb stent occlusion. Results: Baseline limb laterality, thrombus extent, and concomitant PTE were similar. Primary outcome: PTE at six months—0/17 (0%) in the filter group vs 1/21 (4.8%) in the nofilter group (p>0.999). Secondary outcomes: recurrent DVT—3/17 (18%) vs 1/21 (4.8%) (p=0.307); IVC thrombosis—1/17 (5.9%) vs 0/21 (0%) (p=0.447); stent occlusion—1/17 (5.9%) vs 2/21 (9.5%) (p>0.999). Event-free survival also did not differ (log-rank p=0.43).Beyond six months, long-term composite events were infrequent with no significant differences. Conclusion In anticoagulated patients undergoing CDT/PMT for acute IF-DVT, routine prophylactic IVC filter placement did not improve short- or long-term outcomes, including prevention of PTE. These data support a selective, rapid-retrieval strategy for highembolic-risk scenarios.

Objective: This study aimed to evaluate the clinical utility of intraoperative venography in image-guided chemoport insertion, with a focus on catheter tip positioning and procedural safety. Methods: We retrospectively reviewed 270 patients who underwent chemoport insertion via the internal jugular vein between July 2020 and April 2024. Intraoperative venography was used to localize the SVC–RA junction. Patient demographics, catheter tip location, complications, and clinical outcomes were analyzed. Results: Venous stenosis was detected in 9.5% of patients without prior central catheterization and in 23.5% of those with a history of prior access; the difference was not statistically significant (p=0.065). Two cases of severe stenosis required balloon angioplasty before chemoport insertion. Although all catheter tips were positioned intraoperatively within 2 cm below the SVC–RA junction, only 61.5% remained in the intended location on postoperative chest x-ray. Superior migration occurred in 65.2% and inferior in 20.4%, but differences between planned and postoperative catheter tip positions were not significantly associated with complications (p=0.613). Left-sided insertions required significantly longer catheters than right-sided ones (p<0.001), while height, weight, and BMI were not predictive of catheter length. Conclusion Intraoperative venography can be a useful tool for guiding chemoport insertion, as well as for identifying and managing venous stenosis.

Pulmonary embolism (PE) that occurs in patients with severe chronic obstructive pulmonary disease (COPD) can often result in acute exacerbation. Immediate intervention for them is required to prevent acute exacerbations and reduce mortality. A 72-year-old man with severe COPD developed deep vein thrombosis with PE and worsened despite anticoagulant therapy and mechanical ventilation. Thrombolysis was contraindicated due to a history of gastric bleeding 3 weeks ago. He had a pulmonary embolism severity index (PESI) score of 272, placing him in the very high-risk group, with a 30-day mortality rate of 10.0%–24.5%. Mechanical thrombectomy was performed using AngioJet® Solent catheter to remove the thrombus obstructing the right middle and lower lobe pulmonary arteries. The patient improved without complications and was discharged. PE in severe COPD requires immediate intervention due to the higher severity of symptoms compared to the general population, and the use of AngioJet ® Solent catheter may be an effectively alternative modality of treatment.

Addressing the high incidence of late type III endoleaks in previous AFX models, Endologix upgraded the device material and updated its recommendation regarding component overlap. However, whether upgraded AFX2 models are safe for endoleaks remains controversial. Here we report a case of a 67-year-old male with an AFX2-implanted abdominal aortic aneurysm experiencing a delayed type IIIa endoleak. Aneurysmal sac enlargement occurred 36 months post-endovascular aneurysm repair (EVAR), with a computed tomography scan at 52 months revealing component overlap loss and a significant type IIIa endoleak. We performed endograft explantation and endoaneurysmal aorto-bi-iliac interposition grafting.Our findings suggest that sufficient component overlap is necessary when using an AFX2 endograft outside the manufacturer’s instructions for use to prevent late type IIIa endoleaks. Moreover, patients who undergo EVAR with AFX2 for tortuous large aortic aneurysms should be carefully monitored for conformational changes.