Management of Venous Thromboembolism in a Patient with Duplicated Inferior Vena Cava: A Case Report and Literature Review

Anatomic variations of the inferior vena cava (IVC) are rare, occurring in less than 3% of the population, yet they can pose significant clinical and procedural challenges. We report the case of a 68-year-old male with a contraindication to anticoagulation due to gastrointestinal bleeding, in whom IVC filter placement was indicated for pulmonary embolism prophylaxis. During intra-procedural venography, the patient was found to have a duplicated inferior vena cava (DIVC), a rare vascular anomaly. Bilateral Denali filters were successfully deployed in both IVC limbs to ensure complete thromboembolic protection. This patient remains clinically stable at three-year follow-up with no recurrence of thromboembolism or filter-related complications. This case highlights the placement of bilateral filters in patients with DIVCs that do not converge below the renal veins. Recognizing this was crucial to ensure effective filter placement and avoid incomplete protection against embolism. This case underscores the importance of evaluating venous anomalies prior to interventional procedures involving the IVC. Failure to recognize such variations can lead to technical difficulties, procedural delays, or suboptimal outcomes, including persistent or recurrent thromboembolism. We also review the types of IVC anomalies, their embryology, and some of the potential complications they may cause. Careful procedural planning is essential for optimal patient management.