Q1: f - All of the above. Q2: d - 30% per JAHA 2017 study. | Figure 1

SIRRFS

Radiology

Q1: f - All of the above.

Q2: d - 30% per JAHA 2017 study.

The filter was unable to be retrieved utilizing a traditional snare so the decision was made to abort further attempts of filter retrieval at that time. The patient returned 11 days later for repeat attempt at filter retrieval with a laser excimer sheath to circumferentially ablate the fibrotic tissue and permit filter retrieval with subsequent iliocaval reconstruction.

Figure 1: OptEase filter retrieval utilizing Laser Excimer
Figure 2: Infrarenal IVC venogram
Figure 3: Iliocaval reconstruction
Figure 4: Final reconstruction product

The patient experienced no post procedural complications. He was discharged the same day on a Lovenox bridge until he became fully anticoagulated on Coumadin. He returned for follow up one month later with no complaints related to his procedure. His abdominal varices have significantly decreased in size. He does have persistent venous insufficiency for which he is interested in pursuing further treatment.

Laser excimer assisted OptEase filter removal for IVC occlusion with iliocaval reconstruction.

Fellow: Lauren Evans, MD. Attending: Doug McDonald, MD. Program/Dept(s): Interventional Radiology Department, Scott & White Hospital, Temple, TX

  1. IVC thrombosis has developed below indwelling Optease IVC filter, extending below the common iliac veins. A plethora of abdominopelvic collateral pathways have developed.
  2. IVC thrombosis can lead to lower extremity DVT, chronic venous insufficiency, post-thrombotic syndrome, and limb ischemia.
  3. Recurrent VTE after adequate anticoagulation, VTE with contraindications to anticoagulation, VTE with complication from anticoagulation, and inability maintain anticoagulation for VTE.

Lower extremity symptoms from venous hypertension were treated with IVC filter retrieval followed by cavo-iliac reconstruction. Venography of the common iliac veins and IVC demonstrates occlusion at the cavo-iliac bifurcation with prominent collateral pathways. Note indwelling IVC filter. The IVC filter was successfully recaptured with using a laser excimer sheath. Next, a Gianturco stent was deployed just inferior to the right renal vein, followed by an overlapping Gianturco stent in the peripheral IVC. Kissing Wall-stents were deployed at the cavo-iliac bifurcation. Completion venography demonstrates patent IVC and common iliac veins with preferential blood flow through the reconstructed iliocaval system. Case courtesy of Dr. Doug McDonald and Dr. Lauren Evans from Scott and White Medical Center, Department of Interventional Radiology, Texas A&M University.