Transcatheter thrombolytic therapy for symptomatic thrombo-occlusion of inferior vena cava filter

Abstract

Thrombus within an inferior vena cava (IVC) filter reduces filter patency and venous return from the lower extremities, and may progress to complete IVC occlusion. The clinical experiences and outcomes of transcatheter thrombolytic therapy for symptomatic IVC thrombosis following filter implantation have not been widely reported. The aim of the current study was to evaluate the efficiency and safety of trans-catheter thrombolysis for the treatment of symptomatic IVC thrombosis in patients with implanted IVC filters. Transcatheter thrombolysis was used to treat 5 patients with thrombosis of the filter-bearing IVC causing symptoms in 10 limbs from October 2005 to September 2010. The patients were implanted with a second IVC filter through the right internal jugular vein, followed by recanalization of the occluded IVC and intravenous transcatheter thrombolysis. The IVC filters were retrieved through the femoral or right internal jugular vein after the thrombus had dissolved. Technical and clinical outcome, complications and postoperative pulmonary embolism were monitored. A total of 5 filters were implanted and 6 filters were retrieved later. Technically and clinically successful recanalization and thrombolysis were achieved in 5 of 5 patients and 10 of 10 symptomatic limbs. The median thrombolysis period was 13 days (range, 8–14 days). The median dwell time for the filters that were removed was 50.5 days (range, 14–73 days). No major bleeding occurred during the current study. During clinical follow-up, no clinically detectable pulmonary embolism was observed. Endovascular recanalization and transcatheter thrombolysis of IVC thrombosis are efficient, feasible and safe in the presence of an IVC filter.

Endovascular management of inferior vena cava filter thrombotic occlusion

“…A review of the literature demonstrated that little has been written about this entity. 4,[9][10][11] A recent retrospective review of 978 IVC filters placed at a major academic center found only a single case of IVC occlusion complicating filter placement. 12 Another study conducted in a referral hospital with 1718 patients who had IVC filters placed during 2001-2008 found 12 cases of total IVC occlusion.…”

The Development of Marked Collateral Circulation due to Inferior Vena Cava Filter Occlusion in a Patient with Chronic Thromboembolic Pulmonary Hypertension Complicated with Anti-phospholipid Syndrome

“…Because of collateral vein drainage, some patients with IVCF thrombosis may not manifest lower extremity symptoms (17). Conversely, Gurewich et al (33) reported that the resultant venous tributaries serve as alternative routes for PTE.…”

“…Thus, in the present case, the predisposing condition for IVCF occlusion was presumed to be the thrombi in the patient's IVCF and APS. Xiao et al ( 17 ) reported that the development of a thrombus in an IVCF reduced filter patency and venous return from the lower extremities and that it may progress to complete IVC occlusion. Hypercoagulable/malignant conditions may affect the formation of thrombi and IVCF occlusion ( 18 ).…”

Inferior Vena Cava Filter Thrombosis in the Postoperative Neurosurgical Setting: Case Report and Review of the Literature

“…A recent 10-year retrospective review of patients presenting with symptomatic IVC thrombosis concluded that aggressive endovascular treatment of acute IVC thrombosis is safe and effective with an excellent short-term prognosis [ 25 ]. Combined percutaneous mechanical thrombectomy with catheter-directed thrombolysis (CDT) has been shown in several studies to optimize vascular recanalization with minimal thrombolytic dosing [ 12 , 25 - 27 ]. Although the optimal form of endovascular intervention continues to rest on expert opinion, a mechanical approach is recommended as the first-line intervention in the postoperative setting; the alternative being anticoagulation, which is supported in the literature only for nonsurgical patients [ 28 ].…”