Thrombus embolization into IVC filters during catheter-directed thrombolysis for proximal deep venous thrombosis.
OBJECTIVE
To assess the frequency of embolization into retrievable inferior vena cava (IVC) filters during catheter-directed thrombolysis (CDT) and stent placement for acute iliocaval deep venous thrombosis (DVT).


METHODS
Serial phlebograms from 40 patients (28 women; median age 32 years) consecutively treated with CDT for DVT during a 12-year period were retrospectively evaluated for visible emboli in the IVC filter. Clinical and procedural data extracted from a prospectively maintained database were evaluated to identify predictors for embolization into the filter.


RESULTS
Visible emboli were found in 18 (45%) patients. Visible embolization to the IVC filter was less frequent in patients with a hypercoagulable disorder (n = 29, 31%) than in patients without a hypercoagulable disorder (n = 11, 69%; OR 0.1, 95% CI 0.02 to 0.56, p = 0.006). No patient developed clinical symptomatic pulmonary embolism or a complication related to the placement or retrieval of the IVC filter.


CONCLUSIONS
Thrombus embolization during CDT is a common phenomenon in patients with proximal DVT. Placement of a retrievable IVC filter during thrombolytic therapy can prevent silent and symptomatic pulmonary embolism.
Vascular Centre Malmö-Lund, Malmö University Hospital UMAS, Malmö, Sweden. tilo.kolbel@skane.se
Tilo
T
Kölbel
Alaa
A
Alhadad
Stefan
S
Acosta
Mats
M
Lindh
Krasnodar
K
Ivancev
Anders
A
Gottsäter
D000328:Adult; D002404:Catheterization; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007084:Iliac Vein; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000628:therapy*; D055815:Young Adult