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Archives of cardiovascular diseases
Volume 102, n° 1
pages 77-78 (janvier 2009)
Doi : 10.1016/j.acvd.2008.06.009
Received : 21 June 2008 ;  accepted : 24 June 2008
Long-term efficacy of two vena cava filter implants for congenital duplicated inferior vena cava
Efficacité à long terme de l’implantation de deux filtres caves pour une double veine cave inférieure congénitale
 

Ghassan Moubarak , Jean-Marc Schleich, Jean-Claude Daubert
Département de cardiologie et maladies vasculaires, centre hospitalo-universitaire de Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France 

Corresponding author.

Keywords : Vena cava filter, Vena cava, inferior, Pulmonary embolism

Mots clés : Filtres cave, Veine cave inférieure, Embolie pulmonaire


In June 1984, a 61-year-old man presented with pulmonary embolism (PE) in the right lower lobe artery complicating left popliteal deep vein thrombosis. Oral anticoagulants were started. Four months later, the patient complained again of dyspnoea. A lung scan revealed multiple perfusion defects in the left lung suggesting a high probability of PE. No underlying conditions predisposing to thrombus formation were discovered. Since anticoagulation levels had remained within the therapeutic range, placement of an inferior vena cava (IVC) filter was advised.

Venography revealed a right IVC in the normal position and an additional left IVC. The latter originated from the left common iliac vein and ended at the left renal vein, which crossed anteriorly to the aorta joining the right IVC to form a single suprarenal IVC. Two Greenfield filters were inserted percutaneously via the femoral vein into both IVCs. When last seen in March 2008, 24 years after the procedure, the patient was still receiving anticoagulant treatment and had remained free of recurrent clinical thromboembolic events. Fluoroscopy revealed that the two filters were still oriented in parallel directions (Figure 1). Doppler ultrasound confirmed the absence of migration, tilting or occlusion of the filters (Figure 2).



Figure 1


Figure 1. 

Anteroposterior fluoroscopic image showing the two filters oriented in parallel directions with the left filter slightly cranial to the right one.

Image fluoroscopique montrant les deux filtres orientés dans une direction parallèle avec le filtre gauche dans une position légèrement plus crâniale.

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Figure 2


Figure 2. 

Duplex Doppler ultrasound. A: patency of the filters (arrows) placed into the right inferior vena cava (VCI) and left inferior vena cava (VCI 2) along both sides of the aorta (AO). B: color Doppler imaging revealing blood flow in both veins. The left inferior vena cava appeared smaller in size.

Échographie doppler. A : perméabilité des filtres (flèches) placés dans les veines caves inférieures droite (VCI) et gauche (VCI 2) de part et d’autre de l’aorte (AO). B : doppler couleur mettant en évidence le flux sanguin dans les deux veines. La veine cave inférieure gauche a un plus petit calibre que la droite.

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Duplicated IVC results from the non-regression of the left supracardinal vein during fetal development. Its incidence ranges from 0.3 to 3% and its presence should be suspected when recurrent PE occurs after the insertion of an IVC filter. In such cases, dual filter placement may represent a safe and effective treatment against further relapses.

Competing interest statement

All authors declare that they have no conflicts of interest.



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