Presenter: Marco Pontt

Affiliation: Asklepios Klinik St. Georg, Hamburg, Germany

Abstract

This article presents a 23-year-old female with chronic inferior vena cava (IVC) fibrosis causing pulmonary embolism and long-standing exertional exhaustion. Bilateral popliteal mechanical thrombectomy and stent deployment achieved complete symptom resolution, highlighting the link between chronic venous obstruction and cardiac dysfunction.

Introduction

Chronic IVC obstruction often manifests as nonspecific symptoms, mimicking cardiopulmonary disorders. This case underscores the importance of multidisciplinary evaluation in complex venous pathologies.

Case Study

The patient presented with acute dyspnea, bilateral leg swelling, and a history of exercise intolerance. Key findings included:

Lab Abnormalities: CRP 220 mg/L, D-dimer 5.5 mg/L, anemia (Hb 9.8 g/L).

Imaging: Pulmonary embolism originating from IVC thrombosis with fibrotic stenosis at the IVC-left femoral junction.

Intervention:

Bilateral Popliteal Approach: Aspirex 10Fr thrombectomy under general anesthesia.

Stent Deployment: Bentley Beyond stents covered lesions from groin to cardiac atrium.

Follow-up at 1 year confirmed symptom resolution, attributing prior fatigue to chronic IVC-induced cardiac preload deficiency.

Conclusions

1.Chronic IVC obstruction may mimic heart failure and requires comprehensive imaging.

2.Multisegment stenting restores venous return and cardiac function.

3.Early diagnosis prevents irreversible hemodynamic compromise.