Endovascular Recanalization of the Thrombosed Filter-bearing Inferior Vena Cava

PURPOSE

To evaluate the authors' preliminary experience with use of endovascular methods to treat inferior vena cava (IVC) thrombosis in patients with IVC filters.

MATERIALS AND METHODS

Catheter-directed thrombolysis, balloon maceration, mechanical thrombectomy, and stent placement were used to treat 10 patients with thrombosis of filter-bearing IVCs causing symptoms in 18 limbs. Procedural challenges, technical and clinical success, complications, postprocedural filter status, and postprocedural pulmonary embolism (PE) prophylaxis were monitored.

RESULTS

Technical and clinical success were achieved in 15 of 18 (83%) and 14 of 18 symptomatic limbs (78%), respectively. Major bleeding (muscular hematoma) occurred in one patient (10%). Postprocedural PE prophylaxis included anticoagulation (n = 8) and placement of a new filter into a newly placed Wallstent (n = 1). During clinical follow-up, no clinically detectable PE was observed. Data pertaining to late limb status were available at a median of 19 months (range 1–46 months) follow-up in seven patients: three patients were asymptomatic, two patients had ambulatory edema only, one patient had constant mild edema, and one patient had constant severe edema. Postprocedural filter stability was radiographically documented at a median of 255 days (range, 4–1021 d) of follow-up.

CONCLUSION

Endovascular recanalization of the occluded IVC is feasible even in the presence of an IVC filter.

Abbreviations:  DVT, deep venous thrombosis , IVC, inferior vena cava , MT, mechanical thrombectomy , PE, pulmonary embolism , tPA, tissue plasminogen activator