None of these features were visualized in this patient's imaging, thereby supporting the diagnosis of basal
venous thrombus.
The inciting event causing a
venous thrombus to detach and embolize is often unknown [8], but can be associated with clot propagating maneuvers, as there have been case reports citing tourniquet placement as the initiator of clot migration [5].
New oral anticoagulants (dabigatran, rivaroxaban, apixaban, etc.) have been reported in successfully treating left
venous thrombus, without having limitations of vitamin K antagonists which include slow onset of action, regular monitoring, and need for dose adjustments [10].
Taking her age and multiple arterial and
venous thrombus formations in different vascular regions into consideration, a diagnosis of thrombotic storm was considered according to the criteria set by Kitchens et al.
The tumor thrombus of IVC has vanished without any anticoagulant therapy, which indicates that the content of IVC was not a
venous thrombus but the tumor thrombus.
Furthermore, monocytes are involved in the modulation of
venous thrombus ([27-29]).
Since it is often the case that catheter thrombectomy and balloon angioplasty alone are insufficient to completely remove a
venous thrombus, thrombolytic therapy was considered necessary as the next step of treatment in this case, and we decided to administer the thrombolytic therapy in consultation with the treating gynecologist.
The use of animal models to investigate DVT is advantageous enabling the evaluation of new pharmaceutical approaches for prophylaxis and treatment and of how these approaches can interfere in initiation, propagation, and resolution of
venous thrombus.
As the coagulation cascade unfolds, fibrin, red blood cells, and platelets form the intravascular deposit known as the
venous thrombus [23].
It can also detect
venous thrombus in 87% of time and help staging in 85% cases, but it has limitations in detecting tumor in the retroperitoneum.[11] CT scan is the investigation of choice and it can be combined with PET scan (PET-CT) in case of metastatic disease.[12,13] CT or MRI are currently the standard bearer in the diagnosis, staging and surveillance of renal cancers, and they are more useful in delineating the superior extent of tumor in IVC.[14]
The IVC above the filter was then selected and an inferior venacavogram was again performed, this time showing multiple filling defects compatible with
venous thrombus, including thrombus at the superior aspect of the IVC filter, outside of the filter cone.
Conclusion: When used as a standalone procedure, the HOT technique can successfully remove
venous thrombus safely and effectively, and is associated with excellent clinical results at intermediate follow up.
