Author + information
- Received September 18, 2018
- Accepted October 2, 2018
- Published online March 4, 2019.
- Amit Saha, BAa,
- Timothy J. Poterucha, MDb,
- Sahil A. Parikh, MDb,
- Ajay J. Kirtane, MD, SMb,
- Sanjum S. Sethi, MD, MPHb and
- Philip Green, MDb,∗ ()
- aColumbia University Vagelos College of Physicians and Surgeons, New York, New York
- bDivision of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Philip Green, Division of Cardiology, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion 6-610, New York, New York 10032.
Inferior vena cava (IVC) filters are the most common cause of congenitally normal IVC thrombosis (1). Prior reports have demonstrated the use of AngioVac (AngioDynamics, Latham, New York) thrombectomy in iliocaval and right heart thrombi (2).
A 61-year-old man with a history of deep vein thrombosis (DVT) presented with abdominal pain. One month before, he developed sciatica and was found to have a lumbar disc prolapse with a plan for surgery. Due to his history of DVT, an IVC filter was placed pre-operatively. The surgery was complicated by a cerebrospinal fluid leak requiring dural repair. Shortly thereafter, he developed new lower abdominal and leg discomfort with lab results showing an acute kidney injury. A computed tomography abdominal scan with intravenous contrast was performed showing extensive DVT in the inferior vena cava superiorly and inferiorly to the IVC filter, with impaired renal venous drainage (Figure 1). Ultrasound demonstrated thrombus extension into the right atrium (Online Video 1).
The patient was taken to the cardiac catheterization laboratory where aspiration thrombectomy was performed using the AngioVac system. The AngioVac inlet catheter was inserted into the right internal jugular vein with the reinfusion cannula in the left femoral vein. Thrombus was seen superior to the IVC filter. This was aspirated and followed by snaring and removal of the filter through the AngioVac (Figure 2, Online Video 2), which was complicated by subsequent pulmonary embolism (Figure 3). The AngioVac was reintroduced to aspirate additional thrombus (Figure 4). Catheter-directed thrombolysis of the pulmonary arteries was performed using the EKOS system (EKOS Corporation, Bothell, Washington) via the bilateral femoral veins. The patient tolerated the procedure and was doing well on apixaban 6 weeks later when seen in follow-up.
Dr. Poterucha owns stock in Abbvie Inc. and Abbott Laboratories. Dr. Parikh has been an advisory board member for Abbott Vascular, Boston Scientific, Medtronic, Cardiovascular Systems, Inc., and Philips; has been a consultant for Terumo, Siemens, Heartflow, Meril Life Sciences, Asahi Intecc, and Abiomed; and has received research funding from Shockwave Medical, TriReme Medical, and SurModics, Inc. Dr. Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, Cardiovascular Systems Inc., CathWorks, Siemens, Philips, Spectranetics, and ReCor Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 18, 2018.
- Accepted October 2, 2018.
- 2019 American College of Cardiology Foundation
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