“He was concerned if he pulled any harder than he would basically rip the vein out of my body,” Shaida said.


They were at an impasse. Her surgeon didn’t have the tools or expertise necessary. No referrals felt up to the task. Her primary physician put it bluntly: she was too much of a risk. Her likelihood of dying on the table was too high due to both her clotting and her hemorrhaging. Shaida felt that she had no choice but to simply wait until the filter broke free.


The IR solution Finally, in 2022, someone was willing to take Shaida’s case.


“Shaida was basically as complex as a patient can get for DVT issues,” said Zlatko Devcic, MD, an interventional radiologist with the Mayo Clinic in Jacksonville, Florida. “She had a chronically occluded IVC filter, extensive DVT and her iliac veins were completely occluded. That alone would be a complex case. But she also had a blood thinner allergy. She had the whole constellation of difficult issues.”


Dr. Devcic did a full re-imaging and looked at everything, and then told Shaida what she’d been longing to hear: they had options.


“He said, ‘As long as I can see blood flow in your feet, we can do the surgery,’” Shaida said. “Dr. Devcic is my unicorn. He did the impossible, and I was told by multiple doctors that this is just not really something that can be done.”


The retrieval was possible—but wasn’t without risks, according to Dr. Devcic.


“When you’re trying to remove an old filter, there’s a risk that the veins can rupture when you’re trying to remove it,” he said. “There’s a risk of injury to any of the structures around those veins, like the renal arteries. You could rupture the vein and cause significant bleeding and injury to any structures around those veins while you’re trying to remove the filter.”


The procedure itself took almost 12 hours, and Dr. Devcic utilized a laser sheath to burn the tissue around the filter to release it. It was successful; he and his team were able to remove the filter, open Shaida’s veins and place


Endovascular management for iliofemoral deep vein thrombosis


stents to restore blood flow for the first time in 2 years.


“In the end, the procedure worked out well because her filter came out, the veins were reopened, we found a blood thinner that would work for her and she got a lot better after,” Dr. Devcic said.


According to Shaida, her leg still gets swollen, and she still wears compression socks—but her pain levels are down to a two or three, and her mobility has improved.


The importance of DVT awareness Despite Dr. Devcic’s success, Shaida said she still struggles with the reality of what happened to her.


“The whole thing was just traumatic. I’d never had a surgery in my life, and then I end up having six surgeries and 32 days in the hospital in 1 year,” she said. “I feel like this whole process completely broke me just in every way—mentally, physically and emotionally.”


While Shaida’s case was particularly complex, Dr. Devcic says he feels that a lot of DVT patients have experienced similar struggles on their journey to health, purely because they don’t know the options that are out there.


“When patients have clots, they’re sent home on anticoagulation—but a lot are never told that there are other options if they’re not getting better,” Dr. Devcic said. “A lot of these patients don’t get follow-ups. They go home, and whether they get better or not, nobody ever knows.”


irq.sirweb.org | 15


Evidence-based recommendations on the use of IVC filters


Though most patients will benefit from anticoagulation alone, according to an SIR position statement on iliofemoral deep vein thrombosis, patients with severe symptoms can benefit from catheter-directed therapies. However, patient selection is key, and patients with high-bleeding risks, like Shaida, carry additional risks.


But Dr. Devcic hopes that if patients— even high-risk patients—have better education on DVT and awareness of their options, they will know how to advocate for themselves.


“Someone out there can help them,” he said, “even if it doesn’t work out in the beginning.”


Scan to learn more about SIR's guidelines and recommendations for DVT management


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