Pulse-spray catheter-directed thrombolysis with urokinase and argatroban for thrombo- occlusion of an inferior vena cava filter due to heparin-induced.

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Pulse-spray catheter-directed thrombolysis with urokinase and argatroban for thrombo- occlusion of an inferior vena cava filter due to heparin-induced thrombocytopenia with thrombosis Yoshito Ogihara, MD, Norikazu Yamada, MD, PhD, FJCC, Akimasa Matsuda, MD, PhD, Satoshi Ota, MD, PhD, Masaaki Ito, MD, PhD, FJCC Journal of Cardiology Cases Volume 13, Issue 4, Pages 112-116 (April 2016) DOI: 10.1016/j.jccase.2015.12.004 Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 1 Contrast-enhanced computed tomography (CT). (a)–(c) Before catheter-directed thrombolysis (CDT), (d)–(f) after CDT. (a and d) Coronal plane, (b and e) level of common iliac veins, (c and f) level of common femoral veins. Contrast-enhanced CT reveals thrombo-occlusion from below the inferior vena cava (IVC) filter to the right popliteal vein and left femoral vein prior to CDT (a, b, and c), and disappearance of nearly the entire thrombosis with a small amount of residual mural thrombosis after CDT, which resulted in successful retrieval of the IVC filter (d, e, and f). Red arrow: IVC filter, yellow arrow: venous thrombosis, green arrow: residual mural thrombosis, yellow arrow head: deep vein after thrombolysis. Journal of Cardiology Cases 2016 13, 112-116DOI: (10.1016/j.jccase.2015.12.004) Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 2 Venography. (a and b) Through the sheath via the right popliteal vein, (c and d) through the sheath via the left superficial femoral vein. The venography reveals that the thrombosis occluded from below the inferior vena cava (IVC) filter to the right popliteal vein on day 10 of hospitalization (a) and from the left common iliac vein to the left femoral vein on day 17 (c) (red arrow: IVC filter) and that the catheter and wire for catheter-directed thrombolysis (CDT) was placed through the thrombosis (a). The yellow lines indicate the thrombosis. The venography shows almost complete disappearance of the thrombosis after CDT (b and d). Journal of Cardiology Cases 2016 13, 112-116DOI: (10.1016/j.jccase.2015.12.004) Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 3 The summarized clinical course, platelet count, and d-dimer level. IVC, inferior vena cava; CT, computed tomography; AT, antithrombin; UFH, unfractionated heparin; CDT, catheter-directed thrombolysis. Journal of Cardiology Cases 2016 13, 112-116DOI: (10.1016/j.jccase.2015.12.004) Copyright © 2016 Japanese College of Cardiology Terms and Conditions