This was a 23-year-old gentleman with history of May Turner syndrome and protein C deficiency. He had history of left lower limb deep venous thrombosis from left common iliac vein to common femoral vein with mechanical thrombectomy and stenting done in 2022. He was on long term rivaroxaban. However, patient became a gym enthusiast in 2025 and was poorly compliant to anticoagulation treatment to avoid easy bleeding during exercise. He was admitted in August 2025 for left lower limb swelling.

Doppler ultrasound of left lower limb confirms in-stent thrombosis from left common iliac to common femoral vein.

Venogram showed occluded left common iliac vein.

Accesses at right and left popliteal veins were established. A FlowTriever disc was inserted as a temporary inferior vena cava filter via the right popliteal access. Wire was passed through the thrombosed left common iliac to femoral stent. Aspiration thrombectomy was performed and aspirated small amount of chronic blood clots. Subsequent, an "up and over" access was established with a 16 French aspiration catheter inserted through the right popliteal access to the left common iliac stent. The Clottriever catheter was inserted through the left popliteal access into the aspiration catheter. The Clottriever catheter was then retrieved, with simultaneous forward movement of the aspiration catheter to protect the collection basket of the Clottriever catheter from damaging the left common iliac stent during the retrieval process. Moderate amount of blood clots were retrieved with multiple attempts.  Balloon angioplasty was then performed and blood flow through the common iliac vein was restored. There was significant improvement in terms of lower limb swelling after the procedure and the patient was discharged later with anticoagulation therapy.

This demonstrates endovascular thrombectomy via an "up and over" access to treat a case of recurrent deep vein thrombosis with a thrombosed left common iliac to femoral stent. The patient had a good recovery and there is no recurrence of deep vein thrombosis to date.