Endovascular recanalization for filter-bearing inferior vena cava occlusion in a dialysis patient

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Central venous occlusion (CVO) and stenosis (CVS) are frequent complications in patients requiring long-term hemodialysis catheters.
• Endovascular techniques, including balloon angioplasty and stenting, are the mainstay for managing these venous lesions.
• The presence of an inferior vena cava (IVC) filter complicates recanalization due to its intra-luminal position.

Observation:

• A 47-year-old female with end-stage kidney disease (ESKD), systemic lupus erythematosus, and deep venous thrombosis requiring an IVC filter presented with total IVC occlusion below the filter.
• The patient was dependent on a right femoral vein catheter for hemodialysis.
• The IVC filter posed a significant challenge to recanalizing the occluded segment.

Findings:

• Successful management of total IVC occlusion was achieved using sequential balloon angioplasty and stenting.
• The intervention restored adequate venous blood flow through the IVC to the right atrium.
• Dialysis access via the existing catheter was successfully maintained post-intervention.

Implications:

• This case highlights the technical challenges in managing CVO/CVS in dialysis patients, particularly when an IVC filter is present.
• Endovascular recanalization can be a viable option for complex IVC occlusions in the setting of dialysis access and IVC filters.
• Careful pre-procedural planning and tailored endovascular techniques are crucial for successful outcomes in these intricate vascular scenarios.