Treatment of Inferior Vena Cava Filter Thrombosis by Mechanical Thrombectomy and Temporary Vena Cava Filter Protection

Abstract

Inferior vena cava (IVC) filter thrombosis presents a difficult management problem and is associated with a significant incidence of pulmonary embolism. Treatment options in less extensive clots include anticoagulant or thrombolytic therapy, often in combination with placement of a filter above the clot. However, propagation of the clot to the level of the right atrium or the existence of a free-floating thrombus and continued pulmonary embolism may require surgical intervention including vena caval ligation and thrombec tomy. A thrombus that extends to the right atrium may also require thoracotomy and cardiopulmonary bypass. Contraindications to anticoagulant or thrombolytic therapy, as in our patient with a significant bleeding risk from a colon carcinoma and heme-positive stools, further complicate treatment decisions. The authors report the first successful treatment of an IVC filter thrombosis using the combination of mechanical thrombec tomy and temporary vena cava filter protection.