Iliocaval thrombi in pulmonary thromboembolic disease

Rational management of patients with pulmonary thromboembolic disease should include assessment of the risk of additional emboli. Other authors have shown that the possibility of fatal pulmonary embolism is higher when the iliofemoral system contains thrombus, and it is recommended that vena caval interruption rather than simple anticoagulation is indicated. Additional factors governing the therapeutic choice should include the magnitude of the original embolic occlusion as well as the presence of antecedent cardiopulmonary disease. In these instances large thrombi in the iliocaval system should be regarded as potentially life threatening. A sequence of angiography beginning with right iliac and vena caval opacification, proceeding to pulmonary arteriography, and terminating with retrograde left iliac vein study provided information needed to individualize the therapeutic approach. Several case reports illustrate the spectrum of abnormalities and their therapeutic implications.