Use of a Trellis Device for Endovascular Treatment of Venous Thrombosis Involving a Duplicated Inferior Vena Cava

Abstract

Congenital anomalies of the inferior vena cava (IVC) are increasingly recognized with CT and venography techniques. Although many patients with IVC anomalies are asymptomatic, recent studies have suggested an association with venous thromboembolism. We report the case of a 62-year-old woman with extensive venous clot involving the infrarenal segment of a duplicated left IVC who underwent pharmacomechanical thrombectomy and tissue plasminogen activator catheter-directed thrombolysis with complete deep venous thrombosis resolution. To our knowledge this is the first reported case in the English literature of the use of a Trellis thrombectomy catheter in the setting of duplicated IVC.

Angiojet thrombolysis and vena cava filter insertion in a case of a duplicated inferior vena cava

“…A recent study has been published demonstrating short-term success with the use of the Trellis device for DVT in a patient with a duplicated IVC. 13 Similarly, the patient described in this report maintained venous patency with continued resolution of venous thrombosis at 1 year. At operation, it was unclear whether the patient had a duplicated IVC or a left-sided IVC; therefore, the IVC filter was placed in what was visualized to be the only patent infrarenal central vein.…”

“…A recent study has been published demonstrating short-term success with the use of the Trellis device for DVT in a patient with a duplicated IVC. 13 …”

“…8,12 Most recently, pharmacomechanical thrombectomy with thrombolysis has been used to treat thrombosis of a duplicated IVC, but only short-term follow-up is available. 13 We describe a patient who presented with extensive right iliofemoral thrombosis extending into her right duplicated IVC, who was successfully treated with Angiojet pharmacomechanical thrombectomy with thrombolysis (Angiojet, Possis Medical, Minneapolis, Minnesota, USA). This was followed by venoplasty and stenting of her right-sided IVC.…”

Catheter-directed thrombolysis for double inferior vena cava with deep venous thrombosis: A case report and literature review

“…The DVT developed on the right side, where the IVC diameter was smaller than the left, similar to cases presented by other authors. [5][6][7] However, a direct relationship between DVT formation and the diameter of the IVC cannot be assumed because of different combinations of the diameters of the IVC and the communication veins.…”

“…Some authors proposed that if the DVT is in the small IVC, filter implantation can be reserved because the risk of symptomatic PE is very small. 6 Because the catheter operation inside the thrombus can induce thrombus fall-off, 8 we routinely use filters during CDT. For patients <65 y, we use retrievable filters.…”