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OBJECTIVES:
As the incidence of inferior vena cava (IVC) filter placement has increased, IVC thrombosis has become more frequent. This paper describes our recent single center experience using mechanical adjuncts and thrombolysis to restore patency of the occluded IVC associated with IVC filter use.
METHODS:
This is a retrospective analysis of all patients who presented with IVC occlusion subjected to treatment. Analysis was restricted to patients with presumed acute onset of complete occlusion of the inferior vena cava, with an inferior vena cava filter in place.
RESULTS:
Seven patients (mean age 56 +/- 9 years) between July 2012 to July 2015 were treated by mechanical thrombectomy and/or infusion thrombolysis for IVC filter associated IVC thrombosis. All patients were clinically thought to have acute IVC occlusion with mean time from onset to intervention of 1.7 days. Four of seven patients presented with acute worsening of lower extremity swelling alone, two presented with acute renal failure and lower extremity swelling, and the final patient presented emergently with hypotension. All seven patients were treated with thrombolysis, with 4 receiving percutaneous mechanical thrombectomy as well. Mean thrombolysis procedure time was 207 +/- 78 minutes with a mean estimated blood loss of 170 +/- 195 ml. In the two patients with renal failure secondary to renal vein involvement in the IVC thrombosis, renal failure resolved in one. Of the seven patients treated, three of the four patients treated with a combination of mechanical clot aspiration and infusion thrombolysis had minimal residual thrombus remaining in the IVC and restoration of antegrade iliac vein blood flow. The additional patient thus treated was discovered to have chronic thrombosis of the IVC filter. One patient was treated with infusion thrombolysis alone and had no significant residual thrombosis at the conclusion of the procedure. In the two patients with chronic clot in their IVC filters, treatment resulted in minimal clinical improvement. In late follow-up, 5 of 7 patients had mild or absent lower extremity swelling.
CONCLUSIONS:The availability of new percutaneous clot aspiration devices and lysis techniques promises an alternative to complete IVC occlusion in patients with acute IVC filter induced thrombosis. Despite the promise of this type of intervention, the presence of chronic thrombosis is often difficult to diagnose in advance and limits treatment outcomes.