title: Double Barrel In Situ Recanalization of Thrombosed Nonretrievable IVC filter.
abstract: We report a case of endovascular recanalization of complete thrombotic occlusion of the inferior vena cava (IVC) and bilateral iliac veins using the architectural knowledge of the in situ permanent IVC filter in a 23-year-old male. The infrarenal permanent IVC filter was TRAPEASE permanent vena cava filter (Cordis) placed at an outstation hospital for pulmonary embolism. Being permanent variant of filter, percutaneous removal was not possible. The patient had severe venous claudication and an attempt to recanalize the blocked filter was considered, in view of the age no justifiable indication for a long-term filter. After pharmacomechanical catheter-directed thrombolysis, there was residual focal flow-limiting thrombus within the filter. The design of the Trapease Cordis filter was instrumental in our decision to attempt to recanalize the filter in situ using 2 parallel stents with the filter struts as anchoring pillars in a double-barrel alignment. In similar cases of persistent Trapease filter-related thrombotic occlusion of the IVC, this double barrel in situ recanalization shall be a viable alternative to the well-described technique of crushing the filter and recanalizing it with a single stent.
authors.affiliation: Division of Peripheral Vascular and Endovascular Sciences, Medanta The Medicity, Gurgaon, Haryana, India. Electronic address: banerjee_shubhabrata@rediffmail.com.
authors.forename: Shubhabrata
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Division of Peripheral Vascular and Endovascular Sciences, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Hiten M
authors.initials: HM
authors.lastname: Patel
authors.affiliation: Division of Peripheral Vascular and Endovascular Sciences, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Virender K
authors.initials: VK
authors.lastname: Sheorain
authors.affiliation: Division of Peripheral Vascular and Endovascular Sciences, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Grover
authors.affiliation: Division of Peripheral Vascular and Endovascular Sciences, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Parakh
mesh_terms: D002406:Catheterization, Peripheral; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010690:Phlebography / Q000379:methods; D011474:Prosthesis Design; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator