Inferior Vena Cava Filter Occlusion Causing Phlegmasia Alba Dolens.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Thrombosis Management

Background:

• Phlegmasia alba dolens is a rare complication of extensive iliofemoral vein thrombosis.
• Inferior vena cava (IVC) filters, while life-saving, can rarely lead to caval thrombosis.
• This case highlights a unique presentation of phlegmasia alba dolens secondary to a clotted IVC filter.

Purpose of the Study:

• To report a case of phlegmasia alba dolens caused by an occluded IVC filter.
• To illustrate the successful application of a staged endovascular approach for managing acute on chronic caval thrombosis.
• To emphasize the importance of considering IVC filter complications in patients with severe lower extremity venous thrombosis.

Main Methods:

• A 39-year-old patient with protein S deficiency and a history of IVC filter placement presented with severe bilateral leg pain and swelling.
• Diagnostic workup included venous duplex and venography, revealing extensive deep vein thromboses and infrarenal IVC occlusion at the filter.
• Treatment involved IVC filter retrieval, endovascular thrombectomy, and venoplasty.

Main Results:

• The patient presented with extensive bilateral deep vein thromboses extending from the external iliac to the popliteal veins.
• Venography confirmed infrarenal IVC occlusion at the level of the IVC filter.
• Following endovascular intervention and filter removal, the patient showed significant clinical improvement and was discharged on anticoagulation.

Conclusions:

• A staged endovascular approach can be effective for treating acute on chronic caval thrombosis associated with IVC filters.
• Prompt diagnosis and intervention are crucial for managing phlegmasia alba dolens secondary to IVC filter complications.
• This case underscores the potential for endovascular techniques to resolve complex caval thrombotic events.