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A 30 year old lady presented with history of Deep vein thrombosis following pregnancy . There was no improvement following conservative treatment with heparin and warfarin. She developed significant changes in the left leg. We cannulated the occluded left iliac vein and infused Urokinase for 24 hours to dissolve the thrombus. Following balloon dilatation was performed, with restoration of venous flow into IVC. Within 2 weeks, there was good improvement in the edema of the left leg.

Case 02 : IVC Filter Placement In Case Of Pulmonary Thrombo Embolism

Deep Vein Thrombosis involving the Iliac vein can be complicated by an embolus traveling upto the lungs, and obstructing the Pulmonary artery. The symptoms are chest pain, sudden shortness of breath, drop in arterial saturation. Many cases can be fatal. When a diagnosis of pulmonary embolism secondary to DVT has been made, then it is essential to prevent further episodes. Additionally, if on ultrasound examination, the thrombus in the Iliac vein extends upwards into the IVC or is mobile, it should be prevented from traveling upwards. This can be achieved by placing a metal filter into the IVC, which traps the clot as it travels upwards. Placement of the IVC filter can be achieved percutaneously either from the unaffected side via femoral vein cannulation, or by the jugular vein route. The picture above shows placement of a filter via the jugular route in a lady who had already had minor episodes of pulmonary embolism.

An 18 year old girl developed severe deep vein thrombosis in the left leg. Venous Doppler demonstrated thrombosis involving the deep veins of the entire leg, with total occlusion of the left common iliac vein. She was treated conservatively with heparin and warfarin for three weeks, without any improvement. She continued to have severe swelling of the leg.
She was considered an ideal candidate for catheter directed thrombolysis. In the angiographic laboratory, under local anesthesia, the left superficial femoral vein was entered with a 18 gauge needle, and a 5 French sheath positioned in the vein. Angiography confirmed that there was total occlusion of the iliac vein, with no flow going upwards into the Inferior Vena Cava. A guide wire was then carefully pushed through the clot, and negotiated through the occlusion into the Inferior vena cava. A special infusion catheter was introduced over the wire, and an infusion of Urokinase given through this for a period of 24 hours. Check angiography after 24 hours revealed partial flow upwards into the IVC. The entire thrombosed vein was then dilated with an angioplasty balloon, and final angiogram revealed a fully opened vein with excellent flow into the Inferior Vena Cava.
There was significant improvement in the swelling, which totally disappeared within 3 days of treatment. Doppler study 10 days after treatment revealed patent common and external iliac veins, with good recanalization seen in the deep femoral and popliteal veins.