Chronic IVC thrombosis and resultant IVC filter malposition

Case contributed by Assis Prof Faeze Salahshour

Presentation

The patient has a history of previous episodes of DVT-PTE who referred for IVC filter insertion because of recurrent PTE. Intervention via femoral veins failed, and the cardiologist attempted to insert the filter from a jugular vein. The filter could not be inserted in the proper location below the renal veins and lodged at and above the renal veins in an inclined position. CT scan was performed for a detailed evaluation of the venous system and the cause of failed intervention.

Patient Data

Age: 35 years
Gender: Male

The right external iliac vein is narrow in favor of chronic recanalized thrombosis. The left external and common iliac veins are patent but the left common iliac vein is compressed while passing posterior to the right common iliac artery suggestive of May Thurner syndrome.

A longitudinal web-like linear filling defect is seen, within the IVC lumen adherent to its anterior wall in favor of chronic recanalized thrombosis. Multiple abdominal wall collaterals are seen, secondary to chronic IVC and the right external iliac vein thrombosis. Chronic thrombosis of the right hepatic vein is also evident with small intra-hepatic venous collaterals in the right liver lobe. Large collateral mimics the right hepatic vein.

 

Case Discussion

The cause of failed intervention via the left femoral vein was the May-Thurner syndrome. On the right side and in the IVC, chronic recanalized thrombosis was the cause. The malpositioned IVC filter was retrieved successfully.

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