Fig. 1

The line graph depicts the variations in blood pressure, urine output, and norepinephrine usage during the patient’s course of illness. Following the first thrombus aspiration procedure, upon partial recanalization of the IVC, blood pressure and urine output rapidly normalized, accompanied by a sharp decrease in the requirement for vasopressor medications. Subsequent to the second aspiration procedure, similar immediate improvements were observed in blood pressure and urine output. Intraoperative angiographic imaging following DENALI™ filter placement, illustrating unobstructed IVC return flow(a). Intraoperative angiographic images from the first thrombus aspiration procedure (b and c): The pre-aspiration angiography revealed obstruction within IVC, characterized by contrast retention in the lumen distal to the filter and no contrast filling proximal to the filter (b); after aspiration, partial restoration of IVC lumen was observed, accompanied by proximal contrast filling of the vena cava filter, although it was faint (c). Intraoperative angiography from the second thrombus aspiration procedure (d-f): the pre-aspiration angiography revealed extensive filling defects within IVC, with significant contrast stasis extending from the distal end to beneath the filter, and limited contrast reflux near the proximal end (d); post-aspiration angiography demonstrate a notable reduction in the extent of filling defects within IVC compared to the pre-aspiration state, additionally increased contrast enhancement is evident near the proximal end of the filter (e), and unobstructed right iliac vein blood flow is observed (f)