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Successful Treatment Strategy for Duplicate Inferior Vena Cava and Deep Venous Thrombosis: Filter Placement and
Xu Lan1, Fei Yi Dong1, Jia Jia Duan1
1Department of General Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China (mainland).
Insights
This case report details the successful endovascular treatment of deep venous thrombosis (DVT) in a patient with a rare duplicate inferior vena cava (IVC). A tailored filter placement strategy ensured safe and effective thrombolysis, preventing pulmonary embolism.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Deep venous thrombosis (DVT) occurring with duplicate inferior vena cava (IVC) is an uncommon clinical scenario.
- Optimal management necessitates precise imaging, including venography, to guide treatment strategies.
- This report focuses on a successful intervention for a patient presenting with DVT and duplicate IVC.
Observation:
- An 84-year-old male with hypertension presented with acute left lower-limb edema.
- Venography revealed deep venous thrombosis and an incidentally discovered duplicate inferior vena cava.
- Anatomical assessment showed left common iliac vein predominantly draining into the left IVC below the confluence.
Findings:
- A single inferior vena cava filter was strategically placed in the left IVC, below the confluence and renal veins.
- The patient underwent successful thrombolysis and aspiration for DVT treatment.
- This approach safely managed the DVT without complications such as pulmonary embolism.
Implications:
- This case highlights the feasibility of successful endovascular intervention in complex vascular malformations like duplicate IVC.
- A customized filter placement strategy is crucial for managing DVT in patients with duplicate IVC.
- Comprehensive evaluation and tailored approaches enable satisfactory treatment outcomes even in emergency settings.
Abstract:
BACKGROUND Duplicate inferior vena cava (IVC) accompanied by deep venous thrombosis is rare. The optimal treatment plan is determined according to the results of imaging, including venography. In this report, we present a case of successful treatment of a patient with duplicate IVC and deep venous thrombosis (DVT). CASE REPORT An 84-year-old man with history of hypertension was admitted to the hospital because of 4 days of moderate left lower-limb edema. A thorough examination led to the diagnosis of the DVT. The duplicate IVC was discovered during venography. As the blood from the left common iliac vein mainly flowed to the left IVC, and there were no other communicating branches before the convergence of the left and right IVCs, which was located above the 1st lumbar vertebrae body near the junction of the hepatic vein and the IVC, the strategy of placing only 1 filter in the left inferior vena cava were chosen, rather than placing 1 filter above the confluence of bilateral IVC, or placing a filter in each IVC below the level of renal veins on each side. Following that, the DVT was safely treated with thrombolysis and aspiration without the risk of pulmonary embolism. CONCLUSIONS This case report presented the complete evaluation and management of a patient with lower-limb DVT accompanied by the malformation of duplicate IVC. The filter placement strategy with duplicate IVC in the literature was summarized. We concluded that even in emergency situations, with comprehensive consideration, it is possible to perform endovascular intervention successfully and achieve satisfactory treatment results.
