Auspicious Prophylactic Inferior Vena Cava Filter Placement Prior to Iliac Vein Thrombectomy: A Case Report

Purpose: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), affects 1 in 1000 adults annually. DVT and PE are often diagnosed in tandem, with the radiologic diagnosis of one entity often prompting evaluation for the other. In these settings, clinicians must not only determine the appropriate treatment of PE, which can include systemic thrombolysis, catheter-directed thrombolysis, and mechanical thrombectomy, but they must also determine appropriate management of the DVT. The purpose of this abstract is to review the benefits and risks of inferior vena cava (IVC) filter placement as described in the current literature, discuss the major risks of deep vein mechanical thrombectomy in a patient with known PE, and discuss potential major clinical indications for prophylactic IVC filter placement as an adjunct to deep venous mechanical thrombectomy.

Materials and Methods: We report a case of a 17-year-old young woman with B-cell acute lymphoblastic leukemia and acute PE secondary to venous thrombosis within the right superficial femoral, right common femoral, and bilateral external iliac veins. The patient was immediately treated with systemic anticoagulation and subsequently scheduled for suction thrombectomy of right DVT. Before mechanical thrombectomy of the DVT, an IVC filter was placed prophylactically given the patient’s known PE, age, comorbidities, and vital signs. During the procedure, a large clot from the right external iliac vein mobilized proximally and was captured by the filter.

Results: On repeat venography several days later, persistent clot was present within the filter and was removed via suction thrombectomy before the filter was safely retrieved. In this case, filter placement likely prevented conversion to massive PE. The patient ultimately did well clinically and was discharged home without further complication.

Conclusions: Prophylactic IVC filter placement before DVT thrombectomy may confer significant benefit and prevention of potentially massive PE. Various clinical factors must be weighed in the careful selection of these patients. Robust clinical trials are recommended to further delineate indications for IVC filter placement as an adjunct to DVT thrombectomy.