Duplication of the inferior vena cava (DIVC) is a rare congenital anomaly that complicates diagnosis and treatment, especially in patients with deep-vein thrombosis (DVT). We report the complex case of a 64-year-old woman with advanced breast cancer, acute right lower extremity DVT, high-risk pulmonary embolism, and DIVC. The hypercoagulable state from cancer led to the thrombotic events. Pre-procedural imaging identified the DIVC, guiding a staged, cross-access interventional approach. Mechanical thrombectomy was first performed via the left femoral vein, including pulmonary artery catheter maceration, fragmentation, balloon dilation, and thrombus aspiration, rapidly clearing the embolus and improving oxygenation. Angiography confirmed the thrombus source in the right leg, prompting implantation of a single inferior vena cava (IVC) filter below the right renal vein in the right-sided IVC. The patient recovered well with long-term anticoagulation. Twelve-month imaging showed near-complete thrombus resolution. This case highlights the importance of thorough vascular imaging and individualized strategies to safely manage DVT patients with anatomical variations.
Shi et al. (Thu,) studied this question.