Bilateral iliac vein filter deployment in a patient with megacava

An 85-year-old-woman presenting with low back pain developed shortness of breath and right-sided chest pain. She was found to have perfusion defects indicative of pulmonary embolus (PE). Heparin was at first employed, but had to be discontinued because of gastrointestinal bleeding. Caval filtration was the obvious course, but it was found on computed tomography (CT) scan that the suprarenal portion of the inferior vena cava was 55 mm in diameter, and the infrarenal portion 44 mm. These measurements were too large for insertion of a Greenfield filter, for which the maximum diameter should be 28 mm. The right common iliac vein was 28 mm in diameter, and the left external iliac vein 25 mm. Two filters were inserted percutaneously in these vessels. The patient was followed for 9 months. No clinical evidence of recurrent PE or venous insufficiency occurred.