Background: The aim is to measure the need to inferior vena cava (IVC) filter insertion before
catheter directed thrombolysis (CAT) and its effect on the morbidity and mortality.
Methods: A prospective randomized cohort study. It took place at Ain Shams University hospitals
between 2013 and 2016. Thirty cases with left lower limbs extensive iliofemoral deep
venous thrombosis (DVT) (<14 days) were treated by CAT only with no role for pharmacomechanical
procedures. First angiography after starting CATs was done after 24 h to do “lysis
check” followed by another session if not completely resolved. IVC filter usage for
15 cases (high-risk group). They are retrievable type and are removed later on not
immediately. IVC filter loading by emboli was divided into (small 1/3 the diameter)
and (large >1/3). Follow-up was done at interval 3, 6, and 9 months by clinical assessment
(CEAB classification) and duplex study to assess recanalization and valve incompetence.
Results: Thirty cases were collected and divided into 15 without the use of IVC filter and
15 cases used it. Only three cases have large embolic load in IVC (>1/3) and these
patients had positive risk factors (oral contraceptives, previous history of DVT,
and extension of DVT to IVC). Twenty-eight cases had successful lysis, while two patients
complicated and aborted (one had hemorrhagic ovarian cyst and the other had retroperitoneal
hematoma). One case had major complication and needed reintervention due to thrombosed
iliac stents and two cases had minor ones. Six cases with IVC filter failed to be
retrieved. Two cases without IVC filter developed pulmonary embolism (PE). Conclusion: IVC insertion is not recommended for patient with extensive iliofemoral DVT who received
thrombolysis except for those who have strong risk factors or previous history of
PE.
