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Figure 1. A 19-year-old man (patient no. 6). (a) Venography shows venous thrombus distributing from the left common iliac vein to the left femoral vein (arrows). Note that Gunther tulip retrievable vena cava filter (GTF) was implanted at the inferior vena cava with an approach from the right jugular vein. (b) Venography obtained immediately after catheter-directed thrombolysis still shows that much of the thrombus remained. Note that multiple side holes of the catheter for catheter-directed thrombolysis were positioned in the segment of the thrombus (arrows). (c) Venocavography obtained from the right femoral vein shows that thrombus filling greater than the height of filter was captured in the filter (arrows). This image was obtained just after manual aspiration, mechanical thrombectomy and percutaneous transluminal angioplasty were performed. These interventional radiological procedures were performed after catheter-directed thrombolysis, as shown in Figure 1a,b , and prolonged thrombolysis performed subsequently in the ward through the catheter with its tip positioned at the thrombosed segment. (d) Roentgenogram shows a temporary filter (arrow) (Neuhaus Protect, Toray) that was inserted at the cephalad level of GTF before GTF with thrombus was retrieved to be exchanged with a new GTF. (e) Venography through the right femoral vein, obtained after GTF was exchanged for a new one (arrow), shows no thrombus remaining in the inferior vena cava. The new GTF was implanted to continue treatment for the DVT, further avoiding the complication of pulmonary embolism. 7 days after this, metallic stent placement was performed, then venous thrombus resolved and rapid blood flow in the previously obstructed segment due to thrombus in the left common and external iliac and femoral vein was obtained.
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