Extensive Inferior Vena Cava Thrombosis in Trauma when IVC Filter Placement Is Not Feasible Managed Using ClotTriever...

BackgroundManagement of extensive inferior vena cava (IVC) thrombosis following trauma is challenging, particularly when IVC filter placement is unsuitable. The presence of concomitant injuries requiring surgical intervention further complicates decisions regarding anticoagulation and pulmonary embolism prevention.Case PresentationA 40-year-old man presented following a high-velocity motorcycle accident with multiple facial fractures and a left radial shaft fracture. Contrast-enhanced computed tomography demonstrated no solid organ or major vascular injury but revealed extensive thrombosis extending from the infrarenal IVC into the bilateral common iliac veins. Following hemodynamic stabilization and exclusion of intracranial and intra-abdominal hemorrhage, therapeutic unfractionated heparin infusion was initiated. Despite anticoagulation, progressive lower limb swelling developed. Given the extensive thrombus burden and the need for subsequent surgical procedures, further intervention was considered. The suprarenal IVC measured 32 mm in diameter, and concerns regarding filter stability, migration, and reduced efficacy rendered IVC filter placement suboptimal.Intervention and OutcomeFollowing multidisciplinary discussion, percutaneous mechanical thrombectomy was performed using a combined ClotTriever BOLD and FlowTriever system. A 25-mm FlowTriever disc was deployed in the retrohepatic IVC for temporary embolic protection during thrombectomy. Successful thrombus extraction restored caval patency without complications. Lower limb swelling resolved within three days, allowing staged orthopedic and maxillofacial reconstruction. Thrombophilia screening was negative, and the patient completed nine months of rivaroxaban therapy without recurrence.ConclusionCombined ClotTriever and FlowTriever mechanical thrombectomy may be an effective treatment option for extensive traumatic iliocaval thrombosis when IVC filter placement is not feasible or considered suboptimal.