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OBJECTIVES: Post-operative inferior vena cava thrombosis is an uncommon albeit detrimental complication after orthotropic liver transplantation (OLT), leading to transplant failure and pulmonary embolism. We report a case of a patient with a previous OLT who underwent an emergent robot-assisted inferior vena cava (IVC) thrombectomy using Angiovac and Angiojet rheolytic therapy.
METHODS: A 58 year old woman with a history of an OLT for fulminant hepatic failure was found to have a thrombosed IVC on ultrasound imaging. She was taken to the operating room where bilateral femoral veins and right internal jugular vein were cannulated using a micropuncture system. A venogram was procured which indicated an occluded IVC from the renal veins all the way to the confluence of the iliac veins. The patient was placed on venovenous extracorporeal bypass and manual attempt at removing the clot was made by inserting the Angiovac and Angiojet system into the internal jugular and right femoral vein respectively with limited success at removing the clot burden. Subsequently, robot-assisted angiojet therapy was attempted through the right femoral vein which removed the majority of the thrombus with good result.
RESULTS: The completion venogram indicated complete elimination of thrombus and a patent IVC. Post-operatively, her liver enzymes normalized and her IVC and portal vein remained open on follow-up ultrasound.
CONCLUSIONS: Due to the large size of the IVC, complete thrombosis remains a challenge to rectify with manual manipulation of rheolytic therapy. However, robot-assisted thrombectomy provides an alternate method to quickly and effectively remove clot from the IVC. This functionality is especially exigent for thrombosis after liver transplant.