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OBJECTIVE: To study the technical feasibility and procedural outcomes of multimodality endovascular treatment on acute symptomatic inferior vena cava (IVC) thrombosis.
METHODS: Retrospective analysis was performed of consecutive patients between the years 2004 to 2011 with acute symptomatic IVC thrombosis treated by endovascular methods. Demographic data, technique modality and procedure outcomes were collected.
RESULTS: 17 patients (10 male) who ranged in age from 26-72 years (mean, 54 years) with acute (< 2 weeks) symptomatic IVC thrombosis underwent endovascular revascularization. The average onset of symptoms was 4.9 days. Infrarenal IVC thrombus and iliac vein thrombus was identified in all patients. 88% patients had at least one risk factor for IVC thrombosis. 82% had a prior placed IVC filter. Phlegmasia cerulea dolens was the presenting symptom in 7 patients (41%). Multimodality endovascular techniques, including Angiojet thrombectomy (n=13, 76%), Trellis thrombectomy (n=10, 59%), catheter directed thrombolysis (CDT) (n=15, 88%), adjunctive venoplasty (n=12, 71%) and stent placement (n=4, 24%) were utilized in combination for endovascular treatment. Unilateral (29%) or bilateral (59%) popliteal veins were accessed for catherization in 15 patients whereas femoral vein or internal jugular vein was utilized in 2 patients (12%). The number of endovascular procedures ranged from 1-3 (mean, 2.10 precedures). Patients with more than one procedure typically had overnight CDT with TPA 1mg/kg/hour through one or two infusion catheters (n=15). CDT as the sole treatment was performed in 2 patients. Grade III (complete) lysis was achieved in 13 (76%) and grade II (50%-90%) lysis in 4 (24%) patients. No serious procedure-related complications were encountered, although two of the patients died of phlegmasia related complications.
CONCLUSIONS: A multimodality approach to the acutely thrombosed inferior vena cava is very effective at rapid restoration of inline blood flow. The presence of a thrombosed IVC filter does not preclude the use of these techniques.