Abstract
Optimal treatment of inferior vena cava (IVC) thrombosis remains unclear, especially given the contraindications to anticoagulation use and because interventional options remain limited. We present a case of a 62-year-old man with advanced liver cirrhosis who developed IVC thrombosis with symptoms of severe abdominal pain and leg swelling. IVC flow was restored via successful recanalization with a transjugular and common femoral approach after deploying a 22 × 70 mm Wallstent. On follow-up, the patient had a resolution of his symptoms.
Highlights
Inferior vena cava (IVC) thrombosis can lead to considerable enfeebling
The treatment for acute thrombosis if anticoagulation failed was a surgical bypass of the obstructive vein, which carries an elevated risk of mortality and morbidity and a high failure rate
A 6F pigtail diagnostic catheter was advanced from the right internal jugular (IJ) to the right atrium, and contrast was injected into the right atrium that showed an occluded IVC at the junction of the right atrium
Summary
Inferior vena cava (IVC) thrombosis can lead to considerable enfeebling. There are many causes for thrombosis forming in the venous system [1], some of the most common being inherited thrombophilia, malignancy, prolonged immobilization, and cirrhosis. The mainstay of acute thrombosis is anticoagulation, many patients are not candidates for anticoagulation, especially those with advanced liver cirrhosis or coexisting esophageal varices. A 6F pigtail diagnostic catheter was advanced from the right IJ to the right atrium, and contrast was injected into the right atrium that showed an occluded IVC at the junction of the right atrium. A Glidewire advantage was advanced through the right femoral vein but was unable to cross the 100% occluded IVC. A multipurpose catheter was advanced over the Swan wire into the right atrium, and the Swan-Ganz wire was successfully replaced with a Glidewire Advantage (Figure 2A). If IVC occlusion is of thrombosis in etiology anticoagulation is advised after venous stent placement, since our patient had an advanced liver failure with elevated INR, anticoagulation was not started [4]
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