title: Catheter-Directed Therapy is Safe and Effective for the Management of Acute Inferior Vena Cava Thrombosis.
abstract: BACKGROUND
  The management of acute thrombosis of inferior vena cava (AT-IVC) has evolved to catheter-based therapies, the results of which remain uncertain. We report our institution's experience treating AT-IVC using endovascular methods.
  
  
  METHODS
  A 10-year retrospective review of patients presenting with symptomatic IVC thrombosis between the years 2005 and 2014 was performed. Demographic data, treatment modalities, and outcomes were reviewed.
  
  
  RESULTS
  Twenty-five patients (44% men) underwent treatment for acute (<2 weeks) symptomatic IVC thrombosis. Presenting symptoms included pain and limb swelling in 23 (92%), motor dysfunction in 16 (64%), sensory loss in 14 (56%), and pulmonary embolism (PE) in 2 (8%) patients. Phlegmasia cerulea dolens was present in 5 patients, a history of malignancy was identified in 7 patients, and 21 patients had an IVC filter at presentation (Trapease 12, G2X 3, Option 2, Eclipse 2, Meridian 2). Four patients had a documented hypercoagulable state, 21 patients underwent venous angioplasty, and 7 (28%) patients underwent venous stenting of the IVC or iliofemoral veins. Significant (>50% luminal gain) angiographic resolution of venous thrombus was achieved in all 25 patients. Twenty-one (84%) patients reported moderate-to-complete symptomatic improvement immediately after completion of the procedures. Two patients had a clinically symptomatic PE and 1 patient underwent an above-knee amputation secondary to venous gangrene. Other complications included 6 minor bleeding complications (2 local hematoma, 4 hematuria) all of which resolved spontaneously. There were 2 major bleeding complications (1 disseminated intravascular coagulation, 1 retroperitoneal hematoma).
  
  
  CONCLUSIONS
  Endovascular treatment of AT-IVC, regardless of etiology, is safe and effective with excellent short-term clinical results. An aggressive endovascular approach to treatment of AT-IVC is warranted even in the presence of a thrombosed vena cava filter.
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY. Electronic address: Khanjan.nagarsheth@gmail.com.
authors.forename: Khanjan H
authors.initials: KH
authors.lastname: Nagarsheth
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Charles
authors.initials: C
authors.lastname: Sticco
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Ritu
authors.initials: R
authors.lastname: Aparajita
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schor
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Singh
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Saqib
authors.initials: S
authors.lastname: Zia
authors.affiliation: Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Deitch
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult