1. IVC thrombosis has developed below indwelling Optease IVC | Figure 1

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Case Details

  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 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.

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60 y/o male who presented to the IR clinic for consultation of bilateral lower extremity venous insufficiency and recent history of a ruptured venous ulcer for which he was interested in endovenous laser treatment. During the clinic visit, he reported that he had previously had an IVC filter placed in 2008 after sustaining a T11 burst fracture. He also reported that he had a previous imaging evaluation which demonstrated IVC occlusion at the filter site in 2012. The patient notes significant bilateral lower extremity edema requiring the constant use of compression socks.