Spinal Epidural Hematoma After Attempted Catheter Thrombectomy of a Large Iliofemoral Deep Venous Thrombosis: A Case Report.

The authors report the case of an 82-year-old woman with a spinal epidural hematoma following attempted catheter-directed thrombolysis of a large femoral- popliteal deep venous thrombosis. The patient rapidly developed acute motor and sensory paralysis below the level of T7 within hours of the thrombectomy procedure. Computed tomography imaging revealed that the catheter had perforated the wall of the right inferior vena cava and magnetic resonance imaging subsequently demonstrated an extensive T1-S1 dorsal epidural hematoma with compression of the thoracic spinal cord, conus medullaris, and cauda equina. Given the extent of cord infarction and the risks of extensive thoracolumbar laminectomy, decompression was not performed. The incidence, diagnosis, and management of anticoagulation- associated spinal epidural hematoma as well as the indications for catheter-directed thrombolysis of acute deep venous thrombosis are reviewed.