Bohdan Baralo, MD
Resident
Mercy Fitzgerald Hospital
Darby, Pennsylvania
Disclosure information not submitted.
Bushra Jilani, MD
Internal Medicine Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Gabriel Lerman, DO
Associate Professor of Clinical Medicine
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Title: Retrograde Catheter-Directed Thrombolysis of Extensively Clotted IVC Filter to Facilitate Retrieval
Case Report Body:
Introduction: Catheter-directed thrombolysis (CTT) is often used as an adjunct to medical therapy for venous thrombosis (VT) in select patients (younger individuals, with long life expectancy, few comorbidities, and/or limb-threatening ischemia). However, limited data exist regarding the use of CTT for extensive inferior vena cava (IVC) thrombosis when an IVC filter serves as the clot nidus.
Description: A 63-year-old female with a past medical history of provoked pulmonary embolism, hyperlipidemia, hypertension, diabetes mellitus type 2, and obesity. Prior to gastric bypass in 2020, an IVC filter was placed with the plan to have it removed once she was anticoagulated on a DOAC . She presented to the emergency department with progressively worsening back pain that radiated to the left leg. A STAT MRI of the lumbar spine was performed and was negative. A US of the left lower extremity revealed extensive occlusive thromboses of the common femoral, superficial femoral, saphenous, and popliteal veins. The patient went to IR for debulking, where a venogram revealed an extension of the clot up to the IVC filter. Approximately 80% of the clot burden was removed, and the patient was discharged on an OAC but was readmitted a week later for recurrent VT, which was seen on the duplex US ordered for worsening leg pain. She was started on a heparin drip and again underwent mechanical thrombectomy for extensive clot within the same locations. Due to worsening symptoms after debulking, a CT angiogram was ordered which revealed a recurrence within the deep veins and IVC filter. Retrograde CTT of the clot burden in the filter was performed followed by filter retrieval. The patient became asymptomatic afterwards and was discharged to the nursing home on Lovenox.
Discussion: Retrograde CTT of extensive clot burden within the IVC filter could be a safe treatment strategy for safe removal of the IVC filter and can protect the patient from pulmonary embolism.