Successful Inferior Vena Cava (IVC) Filter Insertion for Recurrent Pulmonary Thromboembolism
PACE Hospitals
PACE Hospitals’ expert Pulmonology team successfully managed a 37-year-old female patient diagnosed with recurrent pulmonary thromboembolism and chronic deep vein thrombosis involving both lower limbs. An inferior vena cava filter was successfully inserted to prevent blood clots from travelling from the lower limbs to the lungs. The treatment focused on preventing further pulmonary embolism, maintaining respiratory stability, and reducing the risk of serious complications.
Chief Complaints
A 37-year-old female patient with a body mass index (BMI) of 17 presented to the Pulmonology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of shortness of breath while performing physical activities for one month. She also reported reduced appetite and significant weight loss of 6 kg during the same period. There was no history of wheezing, cough, chest pain, or joint pain.
Past Medical History
The patient had a history of pulmonary thromboembolism and deep vein thrombosis, initially affecting the right lower limb and subsequently involving the left lower limb. She had previously developed gestational diabetes during her first pregnancy, which was resolved after delivery.
She was not a known case of hypertension, persistent diabetes mellitus, or thyroid disorder. During treatment at another hospital, she developed an allergic reaction following the administration of an antibiotic belonging to the cephalosporin class.
On Examination
On examination, the patient was conscious, coherent, and oriented. Respiratory system examination showed no wheezing or other obvious abnormal breath sounds. Cardiovascular examination revealed a clinically stable condition. Both lower limbs were examined for swelling, tenderness, warmth, skin discolouration, and changes in peripheral circulation in view of her history of recurrent deep vein thrombosis.
Diagnosis
Following admission to PACE Hospitals, the Pulmonology team evaluated the patient for exertional breathlessness, reduced appetite, weight loss, recurrent pulmonary thromboembolism, and bilateral lower-limb deep vein thrombosis.
Contrast-enhanced computed tomography of the chest showed fibroatelectatic changes, mainly involving the posterior basal segments of both lungs. A thick-walled cavity was noted in the left posterior basal segment, along with thrombosis involving the right apical segmental pulmonary artery. Contrast-enhanced computed tomography of the abdomen revealed diffuse fatty infiltration of the liver.
Based on the patient’s medical history, symptoms, clinical assessment, and imaging findings, she was diagnosed with recurrent pulmonary thromboembolism associated with chronic deep vein thrombosis involving both lower limbs. Routine blood investigations and coagulation studies were performed to evaluate her overall health, blood-clotting status, bleeding risk, and suitability for the planned procedure.
Based on the confirmed diagnosis, the patient was advised to undergo Recurrent Pulmonary Thromboembolism Treatment in Hyderabad, India, under the expert care of the Pulmonology Department.
Medical Decision-Making (MDM)
After a detailed consultation by Dr. Pradeep Kiran Panchadi, (Consultant Interventional Pulmonologist), along with Dr. Mounika Jetti, (Consultant General Physician and Diabetologist), the patient was assessed for recurrent pulmonary thromboembolism and chronic bilateral lower-limb deep vein thrombosis.
Considering the repeated formation of blood clots and the risk of further clots travelling from the lower limbs to the lungs, inferior vena cava filter insertion was identified as an appropriate preventive treatment.
The inferior vena cava is the major vein that carries blood from the lower part of the body to the heart. A filter placed inside this vein can trap large blood clots before they reach the lungs and cause another pulmonary embolism. The medical team also decided to perform fibre-optic bronchoscopy to examine the airways because the chest imaging showed a thick-walled cavity and fibroatelectatic changes.
The procedure, its purpose, expected benefits, possible risks, and the need for continued medical treatment were explained to the patient and her family. All necessary consent and procedural clearances were obtained.
Treatment
Following the medical decision, the patient underwent treatment for recurrent pulmonary thromboembolism and chronic bilateral lower-limb deep vein thrombosis in Hyderabad at PACE Hospitals under the expert care of the Pulmonology Department.
Before inferior vena cava filter insertion, fibre-optic bronchoscopy was performed under local anaesthesia and strict sterile precautions. The bronchoscopy showed normal airways, and no procedure-related complications were observed.
The inferior vena cava filter was subsequently inserted through the internal jugular vein under anaesthesia. The filter was positioned within the inferior vena cava to help prevent large blood clots from travelling towards the lungs.
During her hospital stay, the patient received anticoagulant therapy, nebulisation, pain-relieving treatment, and other supportive care as required. Her respiratory condition, coagulation status, bleeding risk, vital signs, and overall haemodynamic stability were closely monitored throughout the hospital stay.
The inferior vena cava filter insertion was completed successfully, and the procedure remained uneventful without immediate postoperative complications.
Discharge Medications
At discharge, the patient was advised to continue prescribed medicines to prevent further blood clot formation, support breathing, relieve pain, and aid recovery. She was instructed to take all medications regularly and not stop or change them without consulting the pulmonologist or treating physician, as this could increase the risk of recurrent blood clots or bleeding.
Advice on Discharge
The patient was advised to avoid prolonged sitting, immobility, and long-distance travel that could restrict leg movement. Adequate hydration, gradual physical activity, gentle leg exercises during journeys, and regular blood-clotting tests were recommended.
Emergency Care
The patient was informed to contact the emergency ward at PACE Hospitals in case of sudden chest pain, increasing breathlessness, coughing up blood, fainting, rapid heartbeat, bluish discoloration of the lips or fingers, unusual bleeding, severe leg swelling or pain, or any other alarming symptoms.
Review and Follow-Up Notes
The patient was advised to return for a follow-up consultation with a Pulmonologist in Hyderabad at PACE Hospitals after five days.
Conclusion
This case highlights the successful management of recurrent pulmonary thromboembolism associated with chronic deep vein thrombosis in both lower limbs. Timely inferior vena cava filter insertion helped reduce the risk of further blood clots travelling to the lungs. The patient remained stable after the procedure and was discharged with appropriate precautions and follow-up advice.
Role of an Inferior Vena Cava Filter in Recurrent Pulmonary Thromboembolism
An inferior vena cava filter is a small medical device placed inside the inferior vena cava, the large vein that carries blood from the lower limbs and abdomen towards the heart. The filter is designed to trap large blood clots before they travel to the lungs and cause a pulmonary embolism. A pulmonologist /pulmonology doctor may recommend an inferior vena cava filter when a patient has a high risk of recurrent pulmonary embolism, cannot safely receive anticoagulant treatment, develops complications during treatment, or continues to develop blood clots despite appropriate therapy.
The filter does not treat an existing deep vein thrombosis or prevent new clots from forming. Therefore, treatment to reduce further blood clot formation may still be required when considered safe by the treating doctor. Some inferior vena cava filters are permanent, while others may be removed once the risk of pulmonary embolism has reduced. Regular follow-up helps assess the filter position, identify possible complications, and determine whether removal should be considered.
Frequently Asked Questions (FAQs)
Why was an inferior vena cava filter required in this patient?
The patient had repeated episodes of pulmonary embolism and long-standing blood clots in both legs. This placed her at risk of another clot travelling to the lungs. The filter was inserted to catch larger clots before they could reach the lungs and cause another blockage. It formed an important part of her treatment.
What is recurrent pulmonary thromboembolism?
Recurrent pulmonary thromboembolism means that blood clots have blocked the arteries in the lungs more than once. These clots often begin in the deep veins of the legs or pelvis and then travel through the bloodstream. Repeated episodes can make breathing difficult and put added strain on the heart. Treatment is needed to lower the chance of another episode.
How does an inferior vena cava filter work?
The filter is placed inside the inferior vena cava, the large vein that carries blood from the lower body towards the heart. Blood can continue to flow through the vein, while larger clots are trapped by the filter. This helps stop them from reaching the lungs. The filter does not remove existing clots or prevent new ones from forming.
Does an inferior vena cava filter replace anticoagulant therapy?
No. The filter helps prevent large clots from reaching the lungs, but it does not treat the cause of clot formation. Treatment may still be needed to prevent existing clots from growing and to reduce the chance of new clots forming. The doctor decides whether this treatment is suitable based on the patient’s risk of clotting and bleeding.
How is an inferior vena cava filter inserted?
The filter is inserted through a vein in the neck or groin using a thin tube. Imaging helps the doctor guide it into the correct position inside the inferior vena cava. Once released, the filter opens and stays in place within the vein. In this case, it was inserted through a vein in the neck.
Why was bronchoscopy performed before filter insertion?
The chest scan showed a thick-walled cavity and other changes in the lungs. Bronchoscopy was performed to look directly inside the airways and check for any visible problem. The airways appeared normal, and the procedure was completed safely. This gave the doctors a clearer picture of the patient’s lung condition.
Can an inferior vena cava filter cause complications?
An inferior vena cava filter may sometimes cause problems such as bleeding or infection where it was inserted. In rare cases, the filter may shift, tilt, block the vein, or irritate the vein wall. Regular check-ups help identify these problems early. The patient should seek medical advice if new leg swelling, abdominal discomfort, chest pain, or worsening breathlessness develops.
Can the inferior vena cava filter be removed later?
Some filters can be removed once the risk of pulmonary embolism has reduced. Others may need to remain in place permanently. The decision depends on the type of filter, the patient’s overall condition, and the risk of further blood clots. The treating doctor will decide whether removal is suitable.
Why should prolonged sitting and long-distance travel be avoided?
Sitting still for long periods can slow blood flow in the legs and increase the risk of another clot forming. This risk is greater in people who have already had deep vein thrombosis. Gentle walking, ankle movements, stretching, and drinking enough fluids can help improve circulation. Long journeys should be avoided during recovery unless the doctor advises otherwise.
What follow-up care is needed after inferior vena cava filter insertion?
Follow-up allows the doctor to review breathing, leg symptoms, blood-clotting test results, and the position of the filter. Imaging may be advised to make sure the filter remains in the correct place. The doctor may also decide whether the filter can be removed later. Any new or worsening symptoms should be reported promptly.
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