Fibrin Sheath Thrombosis Treatment Options in A Post Partum Patient with Cardiogenic Shock, The Role of Interventional Radiology: A Case Report

Thrombosis among childbearing women represents a rare yet serious complication, wherein the interplay of endothelial injury, altered flow dynamics, and the prothrombotic state of this period promotes clot formation. When IVC thrombus coexists with high-risk pulmonary embolism accompanied with refractory cardiogenic shock, maternal mortality is extremely high despite aggressive systemic therapy. In such cases, extracorporeal membrane oxygenation (ECMO) is a rescue modality, providing cardiopulmonary support while further interventions are planned. Although data remain limited, recent reports suggest maternal survival rates above 80 % (1-4). We present the case of a 27-year-old postpartum woman who developed acute respiratory distress and rapid cardiovascular collapse only three days after an uncomplicated vaginal delivery. Initial evaluation revealed elevated troponin and D-dimer levels, raising suspicion for pulmonary embolism. Computed tomography pulmonary angiogram was inconclusive. Despite aggressive medical management, the patient progressed to severe cardiogenic shock and required veno-arterial ECMO followed by Impella support. Repeat echocardiography demonstrated a large, highly mobile thrombus at the upper IVC. Ongoing hemodynamic instability persisted despite systemic thrombolysis, prompting urgent mechanical thrombectomy. The thrombus was successfully aspirated with hemodynamic improvement and no procedural complications. Post-intervention, the patient exhibited progressive stabilization, underscoring the role of interventional thrombectomy as a rescue strategy in cases of refractory caval thrombosis with advanced circulatory support.