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Case Reports
. 2017;56(11):1369-1373.
doi: 10.2169/internalmedicine.56.8175. Epub 2017 Jun 1.

Thrombolytic Therapy and Aspiration of Clots were Effective in the Removal of a Transient Inferior Vena Cava (IVC) Filter that Captured a Large Thrombus

Norihito Takahashi  1 , Kikuo Isoda  1 , Masaru Hiki  1 , Shinichiro Fujimoto  1 , Hiroyuki Daida  1
Affiliations
Case Reports

Thrombolytic Therapy and Aspiration of Clots were Effective in the Removal of a Transient Inferior Vena Cava (IVC) Filter that Captured a Large Thrombus

Norihito Takahashi et al. Intern Med. 2017.

Abstract

A 37-year-old woman presented at 37 weeks of gestation with a history of heaviness in her left leg. Enhanced computed tomography revealed a left extensive ileofemoral thrombus, and we employed a transient inferior vena cava (IVC) filter (t-IVCF) before delivery. Although we attempted to remove the t-IVCF on the day after delivery, a large thrombus was captured in the filter. We therefore performed thrombolytic therapy for one week, but a few small clots remained within the t-IVCF. We were ultimately able to remove the t-IVCF under constant negative pressure by aspiration from a side-hole of the sheath. We herein describe the effectiveness of this aspiration technique in our case.

Keywords: IVC filter; aspiration; deep vein thrombosis; pregnancy; thrombolytic therapy.

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Figures

Figure 1.
Figure 1.
An enhanced CT showed a left extensive ileofemoral thrombus at 37 weeks of gestation. The lines (a-i) in the coronal section (A) show the levels of transverse sections (a-i in panels B). The arrows indicate a large thrombus in the vein.
Figure 2.
Figure 2.
A: Continuous images of an enhanced CT after delivery showed that a large thrombus had been captured in the transient inferior vena cava filter (t-IVCF) (red arrows). B: Although we performed mechanical thrombus fragmentation using a pigtail catheter (yellow arrow), the size of thrombus did not change (red arrows).
Figure 3.
Figure 3.
Continuous images of an enhanced CT one week after thrombolytic therapy revealed that the thrombus had shrunk significantly, but a few clots remained in the filter (red arrows).
Figure 4.
Figure 4.
A schematic illustration of the aspiration procedure. After starting aspiration from a side-hole of the sheath, the t-IVCF containing clots was pulled back into the sheath (A). The clots within the t-IVCF were then squeezed out (B) and aspirated into the sheath (C).
Figure 5.
Figure 5.
The aspirated clots consisted of a combination of fresh (A blue arrows and B) and old organized thrombi (A yellow arrows and C).
See this image and copyright information in PMC

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