Thrombectomy of Inferior Vena Cava Fat Embolism after Trauma

Abstract

A 19-year-old man involved in a head-on motor vehicle collision presented with multiple injuries, including a displaced right femur fracture. Two days after presentation, a computed tomography scan was obtained to evaluate new-onset hematuria, and it showed an extensive hypoattenuating filling defect in the inferior vena cava (IVC) (Fig 1), concerning for free-floating fat embolus. The interventional radiology department was consulted for embolectomy due to the risk of pulmonary embolism, contraindication for anticoagulation in the setting of trauma, and decreased likelihood of fat thrombus responding to anticoagulation. Cavogram showed an extensive right iliocaval filling defect (Fig 2a). A suprarenal IVC filter was placed prior to embolectomy to prevent central migration. Following mechanical embolectomy using an Amplatz Goose Neck Snare (Medtronic, Minneapolis, Minnesota) and suction via guiding catheters, a repeat cavogram demonstrated partially embolized fat thrombus trapped at the IVC filter apex (Fig 2b), which was removed with the snare. Histopathology of the fat emboli (Fig 2c) showed “thrombus with entrapped fat.”