PMC5519468_01
A, B: Computed tomography on admission revealed large deep venous thromboses extending from the bilateral iliac veins to the popliteal veins.
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Lower extremity venous ultrasound and computed tomography (CT) revealed large bilateral DVTs extending from the distal iliac veins through the popliteal veins (Fig. 1).
Computed tomography before anticoagulant therapy. A: The bifurcation of the right and left inferior vena cava (IVC). B: The double IVC. C: The right IVC was compressed between an ovarian tumor and the lumbar vertebra. D: The left IVC was compressed between the uterine myomata and the left psoas major muscle.
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The diameter of the IVC stem was 25 mm (Fig. 2A, B). On contrast CT, the right IVC was found to be compressed between the ovarian tumor and the lumbar spine, and the left IVC was compressed between the uterine myomata and the left psoas muscle (Fig. 2C, D).
The placement of the inferior vena cava (IVC) filters. A: A right vena cavogram of the right renal vein ostium. B: The bifurcation of the right and left IVC (upper arrow) and a left vena cavogram of the left renal vein ostium (lower arrow). C: IVC filters were individually implanted in each IVC, caudally to the renal veins.
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After vena cavography, filters were individually placed below the renal vein via the right internal jugular vein in both the left and right IVCs (Fig. 3).
Computed tomography after anticoagulant therapy. A: The inferior vena cava (IVC) filters were visualized in the right and left IVCs. No thrombus was recognized within any filter. B: The previously identified deep venous thromboses had completely disappeared.
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A postoperative evaluation revealed the complete disappearance of the DVT and the absence of any evidence of thrombosis in the IVC filters on CT (Fig. 4) prompted us to remove them at 67 days after implantation.
A: The left and right inferior vena cava filters were removed after performing angiography to confirm the absence of large thrombi on each filter. B: Angiography of the right inferior vena cava (IVC) after filter removal showed no vascular injury. C: The retrievable filters showed a small amount of thrombus deposition and thin film formation. Strut fracture was not observed.
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After confirming the absence of thrombi in the filters with a pigtail catheter (Fig. 5A), we proceeded to retrieve the Gunther Tulip(R) filters through the right internal jugular vein, using the standard Gunther Tulip(R) Retrieval Kit (Cook Medical). Inferior vena cavography with contrast revealed no apparent vascular injury (Fig. 5B). A small amount of thrombus was noted on the filters, with thin film formation, but strut fracture was not observed (Fig. 5C).