Treatment of Inferior Vena Cava Occlusions Associated with Inferior Vena Cava Filters
David Phang, MD, George H. Meier, MD.
University of Cincinnati, Cincinnati, OH, USA.
INTRODUCTION:As the incidence of inferior vena cava (IVC) filter placement has increased, IVC thrombosis has become more frequent. This paper describes our recent single centerexperience 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 ofcomplete 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 associatedIVC 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 presentedwith acute worsening of lower extremity swelling alone, two presented with acute renal failure and lower extremity swelling, and the final patient presented emergently withhypotension. All seven patients were treated with thrombolysis, with 4 receiving percutaneous mechanical thrombectomy as well. Mean thrombolysis procedure time was207 +/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, renalfailure resolved in one. Of the seven patients treated, three of the four patients treated with a combination of mechanical clot aspiration and infusion thrombolysis hadminimal residual thrombus remaining in the IVC and restoration of antegrade iliac vein blood flow. The additional patient thus treated was discovered to have chronicthrombosis 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 thetwo patients with chronic clot in their IVC filters, treatment resulted in minimal clinical improvement. In late followup, 5 of 7 patients had mild or absent lower extremityswelling.CONCLUSIONS:The availability of new percutaneous clot aspiration devices and lysis techniques promises an alternative to complete IVC occlusion in patients with acuteIVC filter induced thrombosis. Despite the promise of this type of intervention, the presence of chronic thrombosis is often difficult to diagnose in advance and limitstreatment outcomes.
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