Venous thromboembolism in the setting of IVC calcification managed with pharmacomechanical thrombectomy and anticoagulation: A case report

In this paper, we describe a case of an otherwise healthy 51 year old Caucasian male who presented with extensive venous thrombosis and a large retroperitoneal hepatoma without active bleeding. On imaging he was found to have focal calciifcation in the juxtarenal IVC and extensive thrombosis of the iliofemoral and femoropoliteal veins as well as the infrarenal IVC. Despite treating the patient with pharmacomechanical thrombectomy and anticoaguation, he passed away likely due to a new pulmonary embolism. According to the literature available to us, IVC calcification is a rare finding in adults and has been associated with an increased incidence of recurrent deep vein thrombosis and pulmonary embolism. While long term anticoagulation has been recommended for patients with recurrent venous thromboembolism (VTE), there is no expert consensus or societal guidelines for the treatment VTE in the setting of IVC calcification, specifically, regarding pharmacomechanical Vs. surgical thrombectomy [1]. Furthermore, no recommendations currently exist regarding whether expectant management Vs. prophylactic anticoagulation is appropriate. In conclusion, disease specific management guidelines by professional medical societies may be needed regarding the utility and appropriateness of pharmacomechanical thrombectomy Vs. surgical thrombectomy for symptomatic cases as well as expectant management Vs. prophylactic anticoagulation for asymptomatic cases in the setting of IVC calcification.