Endovascular Stenting and Factor Xa Inhibitors for Filter-Associated Chronic IVC Occlusion: A Case Series

BACKGROUND Chronic inferior vena cava (IVC) occlusion is a serious long-term complication of inferior vena cava filters (IVCFs) placement, which can lead to severe post-thrombotic syndrome (PTS). Endovascular management associated with anticoagulation may be one of limited options. Here, we present 3 patients with chronic filter-associated IVC occlusion managed with endovascular stenting and Factor Xa inhibitor infusion. CASE REPORT Case 1: A 48-year-old man who presented bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations with a permanent IVCFs placements 16 years before admission was diagnosed as having filter-associated chronic IVC occlusions. Recanalization was performed through endovascular therapy, and factor Xa inhibitor was selected for antithrombotic therapy. Although in-stent occlusion was discovered on the left limb during 1-year follow-up, relief of symptoms was achieved at 36-month follow-up. Case 2: A 75-year-old man with a 6-year history of bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations was found to have chronic IVC occlusions due to permanent IVCFs. Endovascular therapy and factor Xa inhibitor were chosen for revascularization, and symptomatic relief and stents patency were maintained until the last follow-up (30 months). Case 3: A 46-year-old man diagnosed with filter-associated chronic IVC occlusions underwent endovascular stenting and factor Xa inhibitor infusion. Improvement was shown during the first-year follow-up, but recurrence of symptoms and in-stent occlusions were discovered at 18-month follow-up for anticoagulation withdrawal. CONCLUSIONS Despite risks of in-stent occlusions, factor Xa inhibition associated with endovascular may be a safe and feasible management of filter-associated chronic IVC occlusion.