Multimodal Thrombectomy for Complex Venous Occlusions and In-Stent Thrombosis

BACKGROUND: Post-thrombotic syndrome (PTS) is a debilitating complication of deep vein thrombosis, characterized by venous obstructions that impede cephalad flow, elevated venous pressure, and risk of venous ulceration. CASE SUMMARY: A 73-year-old woman with severe PTS presented with multilevel venous occlusions involving the popliteal vein, femoral vein, and common femoral vein, and a thrombosed right external iliac-common femoral vein stent. Given the complex presentation, an endovascular intervention was performed to restore venous patency. The procedure successfully cleared the occlusions and in-stent thrombosis in a single session. The patient's symptoms, including swelling, pain, erythema, and open wound, improved, with patency sustained through 2-year follow-up. DISCUSSION: This case highlights the challenges of managing advanced PTS with multilevel venous obstruction and in-stent thrombosis, conditions associated with significant morbidity. TAKE-HOME MESSAGES: Comprehensive endovascular management can restore venous outflow in complex PTS. Durable outcomes require ongoing surveillance and optimized medical therapy.