Caught in Time: When IVC Filters Save Lives

J INVASIVE CARDIOL 2017;29(12):E201.

Key words: inferior vena cava filter, cardiac imaging

Inferior vena cava (IVC) filters are indicated in patients with venous thromboembolic disease (VTE) in whom anticoagulation is a contraindication. A 71-year-old male with a past medical history of recent hospitalization for coronary artery bypass graft surgery with ischemic cardiomyopathy, mild chronic thrombocytopenia, and suspected history of undiagnosed thrombophilic disorder presented to the emergency room with right lower-extremity (RLE) swelling and discomfort of 1-day duration. Venous duplex of the RLE showed extensive deep venous thrombosis (DVT) extending from the common femoral vein to the gastrocnemius veins. The patient was started on intravenous unfractionated heparin. He subsequently developed chest pain a few hours later, at which point a computed tomography angiogram of the chest was obtained and demonstrated multiple pulmonary emboli (PE) of the distal right pulmonary artery branches. Given the burden of the RLE-DVT, the presence of multiple PEs, and the patient’s marked thrombocytopenia, he underwent IVC filter placement (Figure 1A) with planned catheter-directed thrombolysis of the RLE-DVT once the platelet count was ≥100,000. While performing catheter-directed thrombolysis, follow-up venography showed a large clot trapped by the IVC filter (Figure 1B). The patient was treated with ultrasound-assisted catheter-directed thrombolysis¹ for 12 hours. Follow-up venography revealed a 40%-50% reduction in the trapped clot volume with recanalization of the common femoral vein (not shown). This case highlights the importance of IVC filter placement in patients with extensive proximal DVTs in order to prevent massive pulmonary emboli, possibly associated with sudden cardiac death.

Reference

1.    Grommes J, Strijkers R, Greiner A, Mahnken AH, Wittens CH. Safety and feasibility of ultrasound-accelerated catheter-directed thrombolysis in deep vein thrombosis. Eur J Vasc Endovasc Surg. 2011;41:526-532.

From ¹the Division of Cardiology and ²Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted May 19, 2017.

Address for correspondence: Anwar Zaitoun, MD, St. John Hospital and Medical Center, 22101 Moross Rd, Detroit, MI 48236. Email: anwar.zaitoun@ascension.org