Catheter Directed Thrombolysis for Pulmonary Embolism in Patients With Rare Inferior Vena Cava Variants

Introduction Congenital left inferior vena cava (IVC) with hemiazygos continuation and drainage into the superior vena cava (SVC) is a rare IVC variant and is associated with venous thrombo-embolism. This is the report of a case of hemiazygos continuation of the left IVC receiving catheter directed thrombolysis (CDT) for pulmonary embolism. Report A 72 year old woman presented with progressive dyspnoea, and CT images confirmed the diagnosis of pulmonary embolism. The unusual route of the IVC was observed during the right heart catherisation and CDT. CDT was then performed with a left femoral venous approach. The patient tolerated the procedure well, and the follow up pulmonary angiogram showed no residual thrombus. Discussion The use of CDT for pulmonary embolism in patients with left IVC with hemiazygos continuation and drainage into the SVC has been reported rarely. Awareness of this diagnosis is critical during right heart catheterisation to prevent devastating complications. However, with careful manipulation, right heart catheterisation and CDT can be achieved successfully. Pulmonary embolism in patients with left IVC with hemiazygos continuation and drainage into the SVC can be treated with CDT safely and effectively with caution. It is wise to remember the different anatomical variations during IVC catheterisation.
Highlights • Congenital left IVC with hemiazygos continuation and draining to the SVC is rare and linked to venous thromboembolism (VTE). • IVC variant related pulmonary embolism can be treated with CDT. CDT through femoral vein access is feasible and safe for IVC variant related pulmonary embolism.