Management of the Thrombosed Filter-Bearing Inferior Vena Cava

Sıldıroğlu, Onur; Özer, Harun; Turba, Ulku C.

doi:10.1055/s-0032-1302453

Cited by 37 publications

(17 citation statements)

References 20 publications

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“…In our patient, the disease was complicated by an extensive area of thrombosis involving the right femoral vein and left external iliac vein, for which an IVC filter was inserted. The treatment options for such a complication could be noninvasive, such as using oral or intravenous anticoagulants, or invasive, such as using catheter-directed thrombolysis or power pulse spray [ 19 ]. Other feasible treatment options include mechanical thrombectomy and balloon venoplasty [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

et al. 2018

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Patient: Female, 42Final Diagnosis: Cauda Equina syndrome due to extensive DVTSymptoms: Back pain • incontinence • swelling legs • weakness of the lower limbsMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Rare diseaseBackground:Epidural venous plexus (EVP) engorgement occurs due to many conditions, so it can be easily misdiagnosed. This becomes problematic when the diagnosis requires prompt treatment for a good outcome, especially when it results in cauda equina syndrome (CES). We report a case of extensive iliocaval thrombosis leading to epidural venous plexus and ascending lumbar vein engorgement as an outcome of deep venous thrombosis (DVT) due to probable adverse effects of oral combined contraceptive pills (OCCP).Case Report:A 42-year-old woman presented to a rural medical facility with bilateral lower-limb swelling and skin darkening for 2 days. She was transferred to a tertiary medical facility where her condition deteriorated to severe CES. A lower-limbs ultrasonography confirmed the presence of extensive DVT extending to the lower segment of the inferior vena cava. Spine magnetic resonance imaging showed abnormal enhancement of the conus medullaris with thick enhanced cauda equina nerve roots, consistent with a possible case of Guillain-Barré syndrome. However, there was engorgement of the EVP extending to the ascending lumbar, azygos, and hemiazygos veins, which was misdiagnosed. The patient was managed immediately with low-molecular-weight heparin and steroids. She died 4 weeks after admission due to hospital-acquired pneumonia and acute respiratory distress syndrome, probably due to the high dose of steroids.Conclusions:Acute CES has a wide differential diagnosis. This report describes an unusual cause of CES and emphasizes the importance of early recognition to avoid misdiagnosis and management delay. Early identification of this clinical entity markedly decreases morbidity and mortality and thus improves the prognosis. Likewise, underlying causing factors such as venous congestion due to OCCP-related DVT should be considered in the diagnosis.

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Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

et al. 2018

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“…However, without the use of anticoagulants, the IVC filter can be thrombosed, creating another complex clinical problem. 12 We believed that filter removal at this time would be accompanied by a lower risk of re-bleeding and minimized the observational period without anticoagulants, because the endovascular maneuver of the filter removal would be easier and simpler than if performed later, and leaving the perforated filter in the IVC might have the potential to cause re-bleeding with trunk movement after restarting anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Removal of a Perforated Inferior Vena Cava Filter Complicated by a Large Retroperitoneal Hematoma: Pitfall of Catheter-Directed Thrombolysis

et al. 2015

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Symptomatic caval perforation is rare complication after inferior vena cava (IVC) filter insertion. A 44-year-old woman developed back pain after the placement of retrieval IVC filter during catheter-directed thrombolysis (CDT). Her computed tomography showed a large right-sided retroperitoneal hematoma. After 2 weeks, endovascular removal of the perforated filter was successfully performed without complication. Because thrombolytic agents can accelerate bleeding caused by endovascular procedures, the bleeding rate of the IVC filter deployment during CDT might be higher than expected.

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“…Filter retrieval should be attempted for both retrievable and permanent filters. [38][39][40] Several studies have shown safe retrieval of permanent filters using advanced techniques. [41][42][43][44] If the filter cannot be retrieved, angioplasty and placement of a self-expanding 18-to 24-mm stent across the filter may be performed to exclude the filter from the reconstructed lumen.…”

Section: Technical Considerationsmentioning

confidence: 99%