Endovascular management of inferior vena cava filter thrombotic occlusion

Abstract

Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified. Demographics, clinical data, procedures, and outcomes were extracted. Patients were followed to the last clinic visit or until they died. Results One-hundred eighty filters were placed by our group practice during the study period. Of those, a total of 10 patients were identified. Overall, there were 7 males; the mean age was 57.1 years (25-78 years). The median time between inferior vena cava filter placement and filter occlusion was 105 days (range 5-4745 days). All patients were clinically symptomatic at the time of their presentation. Nine out of 10 patients were successfully managed endovascularly. Trellis™-8 thrombectomy was the most common endovascular strategy performed ( n = 9). Four patients had balloon angioplasty, two of those with stent placement for chronically occluded inferior vena cava/iliac veins. No thromboembolic complications developed during a median follow-up period of 233 days (range 4-1083 days). Conclusions Endovascular management of inferior vena cava occlusion is feasible, safe, and effective in decreasing thrombus burden in the presence of an inferior vena cava filter. Further studies evaluating long-term inferior vena cava patency and optimal surveillance regimen after endovascular management of filter-related inferior vena cava occlusion are warranted.

Inferior Vena Cava Filter Thrombosis Associated with a Free-Floating Thrombus on a Retrieval Hook: A Case Report and Literature Review

“…When IVCFT develops into chronic thrombosis, CDT and PMT may no longer effectively remove the thrombi, so balloon dilatation and stent implantation should be considered to reconstruct the IVC. Branco et al [18] initiated balloon dilatation on 4 patients and stent implantation on 2 out of 9 IVCFT patients, and the occlusions were successfully removed. Cui et al [19] implanted IVC stents in 40 IVCFT patients.…”

Inferior vena cava filter – comprehensive overview of current indications, techniques, complications and retrieval rates

“…In addition, the formation of collateral circulation may lead to recurrent PE [89]. In such cases with caval thrombosis, endovascular management is complex and may include IVC thrombectomy with filter removal and possible stent placement [90]. Endovascular stent placement with thrombectomy has been described in chronically obstructed IVCs with filters in place [91].…”

Feasibility of Endovascular Recanalization in Post-Thrombotic Syndrome of Intentionally Interrupted Inferior Vena Cava

“…Percutaneous recanalization with angioplasty and stenting have progressively replaced open surgery, becoming the current method recommended to treat post-thrombotic syndrome (PTS) [5]. Whereas endovascular recanalization of thrombosed filter bearing IVCs has been previously widely described [6][7][8][9][10][11][12], the potential to recanalize intentionally interrupted IVC has been described in only few case reports [13,14], and only once dealing specifically with external clipping [14]. This study aims to assess the feasibility and safety of endovascular recanalization to open the clip and reconstruct iliocaval confluence after vena cava plication.…”