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Simple hepatic cyst causing inferior vena cava thrombus.

Matthew Christopher Musielak1, Ranjodh Singh1, Elizabeth Hartman1

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Inferior vena cava (IVC) thrombosis caused by external compression from a hepatic cyst was treated with mechanical thrombectomy and tPA. This approach improved venous patency and resolved symptoms, offering an alternative to standard anticoagulation for large clot burdens.

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Area of Science:

  • Vascular Medicine
  • Interventional Radiology
  • Hepatology

Background:

  • Inferior vena cava (IVC) thrombosis is often linked to Virchow's triad: stasis, endothelial damage, and hypercoagulability.
  • Causes include malignancy, congenital anomalies, and external compression.
  • This case highlights external compression by a benign hepatic cyst as a cause of extensive IVC thrombus.

Purpose of the Study:

  • To present a case of IVC thrombosis secondary to external compression from a hepatic cyst.
  • To evaluate the efficacy of transcatheter mechanical thrombectomy and tPA infusion for extensive IVC thrombus.
  • To discuss the benefits of endovascular treatment for IVC thrombosis refractory to standard anticoagulation.

Main Methods:

  • A 72-year-old female presented with symptoms of IVC thrombosis.
  • CT imaging revealed hepatic cysts compressing the IVC and causing extensive thrombus.
  • Treatment involved heparin drip, followed by transcatheter mechanical thrombectomy and tissue plasminogen activator (tPA) infusion.

Main Results:

  • Following mechanical thrombectomy and tPA, the patient experienced near-complete resolution of leg swelling and weakness within 24 hours.
  • Venous patency was improved, and the patient was transitioned to low molecular weight heparin for surgical preparation.
  • This intervention demonstrated effectiveness in managing a large clot burden.

Conclusions:

  • Catheter-based thrombolysis with mechanical thrombectomy offers superior outcomes compared to standard anticoagulation for IVC thrombosis.
  • This approach can lead to better venous patency and potentially reduce post-thrombotic syndrome.
  • It represents a valuable adjuvant treatment for extensive IVC thrombus refractory to conventional therapies.