Double inferior vena cava filter implantation in a patient with duplication of the inferior vena cava

A baffling case of inferior vena cava filter removal in a patient with transposition of the great arteries

A 47-year-old man with a history of transposition of the great arteries after a Mustard atrial switch procedure and prior inferior vena cava filter placement for venous thromboembolism presented for removal before being listed for orthotopic heart transplantation in anticipation of cardiopulmonary bypass cannulation. The filter was retrieved using a right transjugular approach without disruption of his existing atrial baffle. Contingency planning in the event of unsuccessful baffle navigation included a transfemoral everted filter approach. A thorough understanding of unique patient anatomy and multidisciplinary team approach is critical to safe procedural intervention in patients with congenital cardiovascular anomalies.

Successful Treatment Strategy for Duplicate Inferior Vena Cava and Deep Venous Thrombosis: Filter Placement and Thrombolysis Approach

BACKGROUND Duplicate inferior vena cava (IVC) accompanied by deep venous thrombosis is rare. The optimal treatment plan is determined according to the results of imaging, including venography. In this report, we present a case of successful treatment of a patient with duplicate IVC and deep venous thrombosis (DVT). CASE REPORT An 84-year-old man with history of hypertension was admitted to the hospital because of 4 days of moderate left lower-limb edema. A thorough examination led to the diagnosis of the DVT. The duplicate IVC was discovered during venography. As the blood from the left common iliac vein mainly flowed to the left IVC, and there were no other communicating branches before the convergence of the left and right IVCs, which was located above the 1st lumbar vertebrae body near the junction of the hepatic vein and the IVC, the strategy of placing only 1 filter in the left inferior vena cava were chosen, rather than placing 1 filter above the confluence of bilateral IVC, or placing a filter in each IVC below the level of renal veins on each side. Following that, the DVT was safely treated with thrombolysis and aspiration without the risk of pulmonary embolism. CONCLUSIONS This case report presented the complete evaluation and management of a patient with lower-limb DVT accompanied by the malformation of duplicate IVC. The filter placement strategy with duplicate IVC in the literature was summarized. We concluded that even in emergency situations, with comprehensive consideration, it is possible to perform endovascular intervention successfully and achieve satisfactory treatment results.

Case Report: Imaging features of a new type double inferior vena cava malformation and review

Background

Double inferior vena cava (DIVC) is a rare vascular malformation. With advances in radiological techniques and diagnosis, more and more types of DIVC were identified and diagnosed. Recognition of the variety of DIVC seen on imaging is essential for subsequent venous interventions.

Case presentation

A 77-year-old man presented with low back pain with left lower limb pain for 1 month. Scattered petechiae above the skin surface on the left lower leg, especially on the extensor surface, with flaking and mild tingling of the skin, were noted 3 weeks ago. Ultrasound revealed deep vein thrombosis (DVT) in the left lower limb. Computed tomography pulmonary angiography (CTPA) suggested no significant thrombus in the pulmonary artery. Computed tomography venography (CTV) of bilateral lower limbs showed that iliac vein compression syndrome with formation of deep and superficial venous traffic branches in bilateral lower limbs, predominantly on the left side. CTV of the inferior vena cava (IVC) suggested that the left common iliac vein crossed the common iliac artery bifurcation from dorsal to ventral and continued to travel cranially as a ventral vessel, and connected with the ventral IVC anterior to the right common iliac artery. The right common iliac vein extended cephalad as a dorsal vessel, which was narrowed at the level of 4th lumbar vertebra by compression of the hyperplastic bone and the osteophyte. The patient was discharged after right and left common iliac vein angiography and balloon dilation of bilateral common iliac vein.

Conclusion

The formation of both ventrally and dorsally aligned DIVC is rarer. It should be clarified the effects of DIVC on DVT formation, and the importance of imaging for preoperative planning.

One filter may be enough for duplicate inferior vena cava filter implantation in patients with deep venous thrombosis: Two cases report

BACKGROUND

Duplicate inferior vena cava (IVC) is an uncommon congenital malformation, but should be treated carefully under the circumstances of deep venous thrombosis (DVT). However, there is a paucity of clinical guidance on this situation.

METHODS

Duplicate IVC was diagnosed based on the imaging examination that revealed the dual IVC. Deep venous thrombosis was diagnosed by Compression Doppler ultrasonography of both lower extremities with the high-elevated D-dimer. Retrievable IVC filters were implanted to prevent massive and fatal pulmonary embolism. Appropriate anticoagulation therapy was also performed.

RESULTS

Two retrievable filters were successfully implanted and retrieved in two patients with deep venous thrombosis and duplicate inferior vena cava, respectively. During further follow-up, no adverse event was reported.

CONCLUSION

Comprehensive imaging examination might contribute to the diagnosis of duplicate IVC, especially when individual conditions were limited. The position above the confluence of bilateral IVCs might be an appropriate suprarenal retrievable filter insertion location. To deal with different types of dual IVC anatomy, different strategies should be taken into consideration.