Use of Wall stent to exclude a thrombosed inferior vena cava filter

Abstract

The use of inferior vena cava (IVC) filters has increased dramatically over the last two decades. Thrombosis of the IVC is a potentially catastrophic complication of caval filter placement, and its reported incidence ranges 3.6-11.2%, depending on filter type. We present a 69-year-old female with a history of deep vein thrombosis of the right leg. Prior to a planned spinal operation, a Gunther Tulip filter was placed (Cook Medical, Bloomington, IN). Postoperatively, the patient developed bilateral iliofemoral thrombosis that extended into the IVC filter. Several weeks passed, and after unsuccessful attempts at recanalization in the community setting, the patient was referred to our group for treatment. After an unsuccessful attempt at balloon angioplasty, two 10 x 60mm Protégé GPS stents (EV3, Plymouth, MN) were deployed in the common femoral, external, and internal iliac veins bilaterally. After an unsuccessful attempt at retrieval, the Tulip filter was excluded from the IVC using a 16 x 60mm Wall Stent (Boston Scientific, Natick, MA). Unobstructed flow was now noted from the femoral system all the way through the superior vena cava. The patient experienced immediate relief of her symptoms.