A 56-year-old woman presented to the Emergency Department of Parkland Memorial Hospital complaining of chest pain. She had a remote history of a hemorrhagic cerebrovascular accident complicated by pulmonary embolism, for which a Gunther-Tulip inferior vena cava (IVC) filter had been placed 6 years previously. In the triage area, the patient collapsed and was found to be hypotensive. An ECG showed sinus bradycardia with nonspecific ST and T-wave changes ( Figure 1). Bedside echocardiography demonstrated a moderate-sized pericardial effusion with evidence of cardiac tamponade. A pericardiocentesis was performed with removal of 25 mL of blood, and the patient's vital signs stabilized. A portable chest x-ray suggested a foreign body just above the left hemidiaphragm (Figure 2), which was confirmed by computed tomographic (CT) scan of the chest, which revealed a linear metallic foreign body in the left anterior pericardium adjacent to the right ventricle (Figure 3). On the abdominal CT scan, one of the struts from the patient's IVC filter was not visualized with the remainder of the IVC filter (Figure 4). The patient was taken to the operating room, where exploration of the pericardial space demonstrated a small laceration of the right ventricular free wall ( Figure 5) and a linear 3-cm metallic foreign body ( Figure 6) consistent with the missing IVC filter strut. The patient recovered uneventfully from surgery. IVC strut fracture occurs in fewer than 5% of cases, 1,2 and embolization has been reported as a rare complication of strut fracture. 3 DisclosuresNone. References1. Kalva SP, Chlapoutaki C, Wicky S, Greenfield AJ, Waltman AC, Athanasoulis CA. Suprarenal inferior vena cava filters: a 20-year single-center experience.

Background: There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization. Methods: We examined 3326 patients enrolled in the Excellence in Peripheral Artery Disease registry from 2006 to 2019 who were referred for endovascular intervention for IC (n=1983) or CLI (n=1343). The primary outcome was 1-year major adverse limb events, which included death, repeat target limb revascularization, or target limb amputation. Results: Patients with CLI were older and more likely to have diabetes and chronic kidney disease and less likely to receive optimal medical therapy compared with IC. Patients with IC had higher femoropopliteal artery interventions (IC 87% versus CLI 65%; P <0.001), while below the knee interventions were more frequent in CLI (CLI 47% versus IC 12%; P <0.001). Patients with CLI were more likely to have multilevel peripheral artery disease (CLI 32% versus IC 15%, P <0.001). Patients with IC were predominantly revascularized with stents (IC 48% versus CLI 37%; P <0.001) while balloon angioplasty was more frequent in CLI (CLI 37% versus IC 25%; P <0.001). All-cause mortality was higher in patients with CLI (CLI 4% versus IC 2%; P =0.014). Major adverse limb event rates for patients with IC and CLI were 16% and 26%, respectively ( P <0.001) and remained higher in CLI after multivariable adjustment of baseline risk factors. Conclusions: Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01904851. Graphic Abstract: A graphic abstract is available for this article.

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