Inferior Vena Cava Filter Thrombosis in the Postoperative Neurosurgical Setting: Case Report and Review of the Literature

Abstract

There are no definitive treatment guidelines for caval-filter thrombosis in the postoperative setting. Clinical management for partial or complete postoperative inferior vena cava (IVC) occlusion relies solely on expert opinion, anecdotal evidence, and small clinical trials. As such, the primary objective of the present report is to offer a complex case of extensive IVC filter occlusion in a neurosurgical patient with past medical history significant for protein C deficiency. The presentation, unique radiological findings, management, and outcome will be discussed. No similar cases of massive IVC-occlusive disease in a thrombophilic patient early in the postoperative course following neurosurgical intervention are documented in the medical literature.

Keywords: ivc filter; neurosurgery; postoperative complications.

Figure 1. Normal preoperative inferior venacavogram

Image (A) shows post-contrast, normal-caliber, widely patent IVC prior to deployment of the IVC filter. Image (B) displays the Celect retrievable IVC filter following initial placement. The filter is shown below the renal veins and with no evidence of tilting, stenosis, or pre-existing thrombus.

Figure 2. Postoperative lumbar MR imaging

The left pane displays the MRI T2 axial section showing prominent flow voids (boxed) at the level of L4. The right pane displays an MRI T2 sagittal section with prominent ventral epidural enhancement (arrows) that is consistent with engorged vessels. This is shown causing narrowing of the thecal sac. This effect is most severe at the L4 vertebral level (boxed region of left image).

Figure 3. Postoperative abdominal CT imaging

Sagittal and coronal CT imaging illustrating margins (arrows) of extensive, occlusive thrombosis of the inferior vena cava. The thrombus begins slightly proximal to the IVC filter and extends distally to the level of the confluence of the internal and external iliac veins on the left and out of the field of view on the right.