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

Tech Vasc Interv Radiol. 2018 Jun;21(2):65-77. doi: 10.1053/j.tvir.2018.03.002. Epub 2018 Mar 9.


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.

Keywords: catheter-directed thrombolysis; caval thrombus; endovascular therapy; inferior vena cava thrombus; pharmacomechanical catheter-directed thrombolysis; superior vena cava thrombus.

Publication types

  • Review

MeSH terms

  • Angiography, Digital Subtraction
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Phlebography / methods
  • Thrombectomy / adverse effects
  • Thrombectomy / instrumentation
  • Thrombectomy / methods*
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / instrumentation
  • Thrombolytic Therapy / methods*
  • Treatment Outcome
  • Vena Cava, Inferior* / abnormalities
  • Vena Cava, Inferior* / diagnostic imaging
  • Vena Cava, Inferior* / physiopathology
  • Vena Cava, Superior* / abnormalities
  • Vena Cava, Superior* / diagnostic imaging
  • Vena Cava, Superior* / physiopathology
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / physiopathology
  • Venous Thrombosis / therapy*


  • Fibrinolytic Agents