Inferior Vena Cava Filter-Related Thrombus/Deep Vein Thrombosis: Data and Management

Abstract

Recurrent deep venous thrombosis and inferior vena cava (IVC) thrombosis are well-described complications following IVC filter placement. IVC thrombosis ranges in severity of clinical presentation, but can lead to significant morbidity and mortality with incidence rates depending on patient population and type of filter used. Endovascular therapies such as catheter-directed thrombolysis, mechanical thrombectomy, balloon venoplasty, and stenting are safe and effective in restoration of venous patency.

Keywords: IVC thrombosis; deep venous thrombosis; inferior vena cava filter; interventional radiology; thrombectomy; thrombolysis.

Fig. 1

Successful balloon venoplasty and stenting in a 58-year-old woman with chronic thrombosis of the inferior vena cava and bilateral iliac veins after Denali filter (Bard Peripheral Vascular, Tempe, AZ) placement. (a) CT venogram demonstrating occlusion of the IVC and opacification of multiple venous collaterals (arrow—IVC filter). (b) Venography confirms occlusion of the left external iliac vein with mature collaterals draining across the pelvis and into the IVC via lumbar veni collaterals (arrow). (c) Via internal jugular access, an endovascular snare was utilized to capture the filter hook. The filter was then coaxially collapsed in the sheaths (arrow). (d) Sequential 8-mm balloon angioplasty (arrow) of the iliac veins and IVC was performed from each access. (e) 14 mm × 80 mm self-expanding stents were deployed into the IVC immediately cranial to the prior location of the filter. (f) Completion venography demonstrating flow through the stented segments (arrows) without evidence of residual flow-limiting lesion.