INFERIOR VENA CAVA FILTER PLACEMENT FOR PREVENTION OF PULMONARY THROMBOEMBOLISM: CASE SERIES FROM NORTHWESTERN NIGERIA

A. Ismail1, A.B. Umar2, N. Umar2, A.R. Muhammad2, J.I. Ahmad3, M.M. Hassan4, A.M. Tabari5

  1. Department of Radiology, Bayero University, Kano, Nigeria.
  2. Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria.
  3. Department of Surgery, Bayero University, Kano, Nigeria.
  4. Department of Anaesthesia, Aminu Kano Teaching Hospital, Kano, Nigeria.
  5. Department of Radiology, Barau Dikko Teaching Hospital, Kaduna, Nigeria.

Abstract

Background: Inferior vena cava (IVC) filter placement is an image-guided procedure aimed at primarily preventing pulmonary thromboembolism in patients with lower limb venous thromboembolic (VTE) disease. In Northern Nigeria with a relatively high incidence of thromboembolic disease such as Deep vein thrombosis, reports on IVC filter placement are largely low. We report the feasibility of IVC filter placement on eight patients for the first time in a typical low-resource setting in Northern Nigeria.

Case Presentations: We had an equal number of males and females of the eight patients. Their ages ranged from 20 to 80 years. Five patients presented with bilateral lower limbs Deep vein thrombosis (DVT) of which one had a pulmonary embolism. Two other patients had extensive left femoral DVT and one had extensive IVC,iliac, femoral, and popliteal veins thrombosis. The medical records of seven patients, who had IVC filter placement in our department, were reviewed. The IVC filter was deployed with the aid of a C-arm fluoroscopic unit. In a single case, access was secured via an indwelling dialysis catheter.

Conclusions: All the patients had successful deployment with satisfactory postprocedure conditions. The intended benefit of pulmonary embolism prevention was achieved in the series of procedures that were performed. Indicating the value of IVC filter even in resource-poor settings and effort should be made towards exploring such intervention.

Keywords: Case report, Inferior vena caval filter, Deep vein thrombosis

Correspondence:

Dr. A. Ismail
Department of Radiology,
Bayero University, Kano,
Nigeria.

Email: aismail.rad@buk.edu.ng
Submission Date: 6th Sept., 2023
Date of Acceptance: 30th Dec., 2023
Publication Date: 30th Jan., 2024

Introduction

Inferior vena cava (IVC) filters are devices, deployed in the infrarenal segment of the inferior vena cava, to mechanically prevent lower limb and pelvic venous thrombi from reaching the pulmonary circulation.1 Deep vein thrombosis (DVT) is the formation of clotsm in the deep veins, mainly in the lower limbs and pelvic cavity.2 In Africa, the prevalence of venous thromboembolism (VTE) risk was up to 50.4% overall, 62.3% in medical, and 43.8% in surgical patients.3 We have earlier found that up to 55.8% (95) of patients presenting with leg swelling for vascular ultrasound have DVT while 44.2% (75) had normal ultrasound findings.4 The most important complication of DVT is pulmonary thromboembolism, which can cause high mortality due to sudden interruption of gaseous exchange in the lungs.5

Anticoagulation and thrombolysis, the common pharmacological treatment of lower limb DVT, are beneficial in preventing pulmonary thromboembolism.6 Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolismand deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement globally.7

Despite the high prevalence of DVT and eligible patients for IVC filter placement, the utilization of IVC filter placement in Nigeria is low, even though there is relative availability of interventional radiology services in the region.8 We, therefore, report the series of eight patients with DVT and contraindications to anticoagulation who had IVC filter placement; to document the feasibility, patients’ characteristics and the availability of such life-saving services in a lowresource setting.

Due to the need for active management of venous thromboembolism (VTE), an internal jugular or femoral access is mostly used to place the IVC filter Irrespective of the access vessel, a right-sided approach is preferred due to the direct path to the inferior vena cava and minimal tilt. 9 Comfort, ease, and a comparatively straight course make the right internal jugular vein the more common choice; this approach also decreases the risk of interference with a thrombus, if present in the femoral or iliac vein. However, the femoral vein approach is preferable for patients with central venous catheters, intubated patients, or when using intravascular ultrasound.10