Treatment of inferior vena cava filter thrombosis by mechanical thrombectomy and temporary vena cava filter protection - A case report

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 thrombectomy. 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 thrombectomy and temporary vena cava filter protection.