Caval Thrombus Management: The Data, Where We Are, and How It Is Done

Thromboses of the superior and inferior vena cava, either isolated or associated with distal deep venous thrombosis, are uncommon, but confer potentially serious morbidity and mortality. Incidence is increasing, especially with the prominence of intravascular devices. The range of treatment options is also expanding to include medical management, surgery, and endovascular techniques which are now frequently considered first line therapy due to lower reintervention rates and decreased periprocedural morbidity. Currently, there are no official guidelines for screening or treatment. This article reviews the etiology, diagnosis, and management of caval thromboses, including equipment, procedural steps, outcomes, and complications, particularly with regard to endovascular techniques, such as catheter-directed thrombolysis, pharmacomechanical catheter-directed thrombolysis, angioplasty, and stenting.