What is inferior vena cava thrombosis (IVC)?
Inferior vena cava (IVC) thrombosis is a disease associated with high morbidity. Although the condition is considered rare, case reports have shown that IVC thromboses may be underdiagnosed. For example, most commonly, pulmonary emboli are thought to arise from a lower extremity deep venous thrombosis.
What is IVC filter thrombosis?
IVC filter thrombosis is the main long-term unwanted side effect of IVC filters. When this occurs, venous flow from the lower extremities is impinged.
Are IVC thromboses underdiagnosed?
Although the condition is considered rare, case reports have shown that IVC thromboses may be underdiagnosed. For example, most commonly, pulmonary emboli are thought to arise from a lower extremity deep venous thrombosis. However, there are cases where an IVC thrombus caused the discovered pulmonary embolism.
What are the signs and symptoms of venous thrombosis (IVC)?
The vague nature of symptoms may delay diagnosis until clot migration to the lungs, and renal veins occur, which leads to shortness of breath and oliguria, respectively. The presence of bilateral lower extremity edema and dilated superficial abdominal veins suggests the possibility of an IVC thrombus.
What are the risk factors for IVC filter thormbosis?
And yet, not all is known about the risk factors that lead to it. Most publications are retrospective. Furthermore, most are of a particular type of filter in a non-homogeneous group of patients. Nevertheless, the following factors have been implicated:
How to treat thrombosis of the inferior vena cava?
Treatment of inferior vena cava filter thrombosis starts with anticoagulation. One small series showed that thrombus propagation did not change if antico agulation was given or not. Next, an assessment of whether the filter can be retrieved is made. If it can be retrieved after adequate anticoagulation and thrombus regression, that should be the next step. For many patients anticoagulation is not enough. In these cases intervention is needed. There are series of inferior vena cava catheter directed thrombolysis and of angioplasty. Stent placement is optional and often utilized after a large area of the vena cava has been cleaned of thrombus.
What are the complications of inferior vena cava filters?
Inferior vena cava filters are known to be associated with complications. Some complications become more prevalent as time since insertion increases. For instance, deep vein thrombosis. But a dreaded complication is IVC filter thrombosis. A thrombus that winds up in an inferior vena cava filter can originate distally or arise locally. It is not always possible to ascertain the source. Understanding this has more than just theoretical implications. If the thrombus is local it should be regarded as a complication of the filter. But, if it came from the legs perhaps this is just evidence of proper filter function. The incidence of inferior vena cava filter thrombosis has been reported to range from 5-30%.
What is the most important factor in thrombosis?
Filter design is probably one of the most important factors associated with risk of thrombosis. Because there is lack of head to head comparisons between filters this can only be extrapolated from single filter studies. Double basket design filters probably carry more risk. Examples include the Optease® and Trapease® filters.
Is anticoagulation effective for inferior vena cava filters?
The effect of long-term anticoagulation for patients with inferior vena cava filters is debatable . There is circumstantial evidence to suggest that anticoagulation should be administered when possible. This evidence arises from analysis of two types of data-sets:
Can IVC filter cause thrombosis?
IVC filter thrombosis is the main long-term unwanted side effect of IVC filters. When this occurs, venous flow from the lower extremities is impinged. Nevertheless, not all patients are symptomatic. When they are the most typical symptoms are bilateral leg swelling, heaviness and ulceration. This can become very severe post-phlebitic syndrome. Back pain and other non-specific symptoms are common. Phlegmasia cerulea dolens has been described as a consequence of filter thrombosis.
Is there a difference in the rate of thrombosis in published prepic data?
First is the PREPIC data. I have elaborated on this in a separate article concerning inferior vena cava filters and anticoagulation. My conclusion was that there was no difference in the rate of thrombosis in published PREPIC data between patients with and without anticoagulation.
What is the IVC?
Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter. Due to the substantial increase in the number ...
What is the most common cause of thrombosis of the inferior vena cava?
In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter.
What is the IVC in a thrombosis?
Thrombosis of the inferior vena cava (IVC) is an underrecognized entity with a variety of clinical presentations. The general concepts of deep venous thrombosis (DVT) and thrombophlebitis are discussed in detail in Deep Venous Thrombosis. However, the implications and complexity of IVC thrombosis (IVCT) merit specific attention. [ 1, 2]
What is the medical management of vena caval thrombosis?
Medical management of vena caval thrombosis focuses on anticoagulation and thrombolytic therapy. Surgical management of this condition consists of caval interruption, thrombectomy, or endovascular interventions.
What is the outcome of IVCT?
The outcome of patients with IVCT is often determined by the underlying condition that initially caused the thrombosis. However, some general statements can be made. The impact and outcome of IVCT are as variable as the clinical presentation. In one study, only one third of patients had a correct diagnosis before venography. Adult patients with ligation of their vena cava reportedly have either no symptoms or mild edema after ligation. [ 43]
What causes trauma to the Virchow triad?
Unique among causes, trauma combines the limbs of the Virchow triad. Stasis, vessel injury, and hypercoagulability may all exist in the same clinical situation. Direct trauma to the IVC may be the result of either penetrating or blunt trauma. [ 31, 32, 33] In the absence of venous laceration, blunt endothelial damage has been postulated to cause IVCT. Other mechanisms observed secondary to trauma include extension of hepatic venous thrombosis and thrombus formation after perihepatic packing.
What is absent IVC?
Absent IVC is an extremely rare anomaly that is associated with idiopathic DVT, particularly in the young. Controversy exists as to whether an absent IVC has a true embryonic etiology or whether it is the result of perinatal IVC thrombosis causing regression and disappearance of the once present IVC.
Which organ system is associated with IVCT?
Other retroperitoneal organ systems that have been shown to cause IVCT include the pancreas and the kidneys. Polycystic disease of the right kidney has reportedly been clinically associated with thrombosis of the IVC. [ 27] Pancreatic pseudocysts have been observed to cause thrombosis of the IVC. [ 28] Acute pancreatitis has also been found to generate thrombosis of the IVC. [ 29, 30]
Can hepatic abscesses cause thrombosis?
Hepatic abscesses, either from amebae or echinococci, can also generate thrombosis of the IVC from compression. Because of the propensity of these processes to evolve over time, patients may present without symptoms suggestive of IVC occlusion. They may only demonstrate evidence of the primary process or of collateral venous hypertrophy. The initial presenting symptom may even be pulmonary embolization.
Can IVCT be de novo?
IVCT is often a result of IVC filter thrombosis, but it can also occur de novo. Although anticoagulation remains the standard of care, endovascular techniques to restore IVC patency have become key adjunctive therapies in recent years. This study examines a single-center experience with diagnosis and management of IVCT.
Is IVCT a rare event?
IVCT is a rare event and is associated with known risk factors for venous thromboembolism. PE can occur in roughly 25% of patients presenting with IVCT. Presence of a filter does not appear to confer an advantage in preventing PE when IVCT occurs. Although majority of IVCT is managed with anticoagul ….
Can IVCT be PE?
PE can occur in roughly 25% of patients presenting with IVCT. Presence of a filter does not appear to confer an advantage in preventing PE when IVCT occurs. Although majority of IVCT is managed with anticoagulation alone, endovascular interventions, including lysis and stenting, can safely restore patency in most properly selected patients.
How to treat inferior vena cava thrombosis?
Inferior vena cava thrombosis can also be treated by endovascular techniques. The goal is not always to remove all the clot, but rather to obtain a channel of flow. Techniques use mechanical thrombectomy and pharmacological thrombolysis.
What is the clinical suspicion of a thigh clot?
Clinical suspicion – When the lower extremity is swollen far more than can be explained by a thigh clot, think of a higher obstruction. Other clues include bilateral swelling and scrotal or labial swelling. Lack of respiratory variation on lower extremity venous duplex ultrasound suggests a more proximal obstruction to flow.
How long does it take for a large clot to dissolve?
This includes anticoagulation. It is the experience of many that even very large clot burden can dissolve with proper anticoagulation within a matter of months. Most would recommend treating incidentally found asymptomatic IVC thrombosis.
Can inferior vena cava cause IVC?
Inferior vena cava thrombosis can cause the IVC syndrome. The IVC syndrome is not subtle. People suffer from swollen legs, heaviness and pain. A severe form of the post-phlebitic syndrome can occur. A rare consequence of inferior vena cava thrombosis is cauda equina syndrome. The thrombus can extend from the IVC into the lumbar veins.
Can inferior vena cava thrombosis cause atretic leg pain?
They range from none to devastating. They can be unilateral or bilateral. If the thrombosis is left untreated the IVC may shrivel away and become atretic. This can make the problem even worse and prevent treatment. Inferior vena cava thrombosis can cause the IVC syndrome. The IVC syndrome is not subtle. People suffer from swollen legs, heaviness and pain. A severe form of the post-phlebitic syndrome can occur.
Is IVC thrombosis a form of deep vein thrombosis?
However, native IVC thrombosis is also encountered. While it is a form of deep vein thrombosis, the natural history of IVC thrombosis is variable. It ranges from remaining asymptomatic for the long-term to debilitating bilateral leg swelling. Inferior Vena Cava Thrombosis.
What does lack of respiratory variation on lower extremity venous duplex ultrasound suggest?
Lack of respiratory variation on lower extremity venous duplex ultrasound suggests a more proximal obstruction to flow.
What questions should I ask myself when considering catheter-based intervention for IVC thrombosis?
Jaff explained, "There are three basic questions I ask myself when considering catheter-based intervention for IVC thrombosis: (1) How long has the patient had symptoms/signs suggestive of this, and how severe are they? (2) What is my estimation of bleeding risk? (3) Do I have an interventionist with skill and experience available to perform the intervention?"
What is the cause of inferior vena cava thrombosis?
NEW YORK (Reuters Health) - In the absence of a congenital anomaly, the main cause of inferior vena cava (IVC) thrombosis is the presence of an unretrieved IVC filter, researchers report.
Why does IVC go undiagnosed?
Because of the ambiguous symptoms and insidious onset, IVC thrombosis often goes undiagnosed until clot migration or embolization into the lungs and renal veins results in dyspnea and oliguria.
Can a duplex ultrasound be used for thrombosis?
Lower extremity duplex ultrasound can be used to screen for IVC thrombosis, but appropriately timed CT and MRI are essential for diagnosis and assessment of the extent of thrombosis.
Can a patient with fibrotic thrombosis have a PMCT?
While acute thrombosis may be amenable to PMCT and catheter-directed thrombolysis (CDT), the presence of a fibrotic component in patients who present late may require balloon venoplasty with or without stenting.
