BackTable Vascular & Interventional Ep. 625 Managing Acute Arterial Thrombosis: Devices & Approaches with Dr. Shang Loh and Dr. Khanjan Nagarsheth
Mar 17, 2026
Dr. Khanjan Nagarsheth, vascular surgeon and professor at the University of Maryland, specializes in PAD, venous disease, vascular compressions, and endovascular thrombectomy. They compare thrombectomy devices versus lysis. New device types and the Arctix flow-rest funnel get attention. Strategies for fem-pop, iliofemoral, and visceral thrombosis are outlined. Training needs and device limitations are discussed.
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Prefer Single Session Percutaneous Thrombectomy
- Do favor single-session percutaneous approaches when possible to avoid ICU lytics and lengthy OR schedules.
- KJ moved from overnight lysis and cutdowns to one-stage thrombectomy using new aspiration and mechanical devices after COVID strained ICU/OR resources.
Dual Mechanism Devices Preserve Wire Access
- Combining mechanical retrieval and aspiration preserves wire access and offers dual-action clot removal.
- Dr. Shang Lo values devices that let the operator keep a wire in place to avoid repeated re-navigation during thrombectomy.
Debulk Proximally Then Arrest Flow
- Do debulk proximally with aspiration first and avoid crossing the distal cap to reduce distal embolization.
- KJ prefers aspiration to create a channel, then uses a covered funnel (Artex) to arrest flow before mechanical passes over an 0.014 wire.