Acute Thrombosis of the Inferior Vena Cava Treated with Mechanical Trombectomy

Objective: Deep vein thrombosis involving the inferior vena cava (IVC) without a concomitant neoplastic disease is a rare localization of this pathology. Interventional treatment is associated with a higher risk of pulmonary embolism, ina addition, a high reaching thrombus may make it difficult or impossible to use a filter.

Methods: A 46-year old woman reported to our clinic on the 8th day after the abdominoplasty with massive edema involving both lower extremities, back and abdominal pain, with developing symptoms of phlegmasia. A Duplex and CT scans showed extensive thrombosis from the level of ankles to the renal veins, with a large free-floating thrombus in the IVC.
Transjugular access was performed and IVC filter was placed over the thrombus. A 12-F introducer sheath was passed between the struts of the filter and mechanical thrombectomy was performed using the Lightning 12 and SEP12 (Penumbra, Inc.). The huge clot was removed from the IVC with a retrograde approach. Compression of the left iliac vein did not allow the catheter to be passed through the retrograde access, so an antegrade approach through the popliteal vein was used. An iliac vein angioplasty with stent implantation was performed. During the procedure, a free-floating piece of thrombus caused blockage of the filter. In the next step, the filter was also cleaned with the Lightning 12 Penumbra system and then the filter was removed.

Results: Normal venous latency and resolution of symptoms were achieved. No symptoms of pulmonary embolism were observed.

Conclusions: Mechanical thrombectomy methods allow removal of even very extensive thrombi in patients not suitable for transcatheter thrombolysis. The IVC filter thrombotic occlusion during the procedure can be treated simultaneously during the procedure.