Postlaparoscopic traumatic inferior vena caval thrombosis

Angio-Jet Thrombolysis for Traumatic Inferior Vena Cava Thrombosis; Case Report and Review of Literature

Background

Inferior vena cava thrombosis (IVC-Th) is a rare clinical entity after blunt abdominal trauma. It has both diagnostic and therapeutic dilemmas. Pulmonary embolism is the most dreadful complication and the leading cause of mortality after IVC-Th. Therefore, accurate prompt diagnosis is crucial.

Objective

The aim of this article was to present a case of IVC-Th in a young male patient who had a blunt traumatic abdominal injury after a motor vehicle accident.

Case presentation

The patient was brought to emergency department and was successfully managed by angio-jet thrombolysis. He developed a transient contrast nephropathy that was recovered after continuous renal replacement therapy. Several management options have been proposed in the literature, including conservative, endovascular and operative management.

Conclusion

Angio-jet is a recent promising technique for managing of venous thrombosis. However, its use in cases of IVC-Th is not extensively discussed in the literature.

Inferior vena cava thrombosis: a review of current practice

Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.