Case report on the non-operative management of a retrievable inferior vena cava filter perforating the duodenum

Abstract

HighlightsIVC filters as an alternative to anticoagulation therapy carry their own risks.IVC filters may erode into surrounding structures.Duodenal perforation by a retrievable IVC filter is a rare and serious complication.Caval enteric perforation by retrievable IVC filter can be managed non-operatively.

A technique for taping inferior vena cava caudal to the duodenum: duodenal penetration by IVC filter strut after retroperitoneal lymph node dissection—usefulness of the mesenteric approach

“…Although the incidence of perforation of the IVC wall is 0.2% in patients undergoing IVC filter placement [4], the actual incidence of duodenal perforation is unknown. From 1972 to 2017, only 25 cases similar to our case have been reported [3, 5–8]. Herein, we report a very case of duodenal penetration by an IVC filter strut after retroperitoneal lymph node dissection (RPLND).…”

“…It is still controversial whether repair of a penetration site in the duodenum is necessary. Although we repaired duodenal penetration by EGD clipping in the present case, duodenal penetration was not repaired in another report with an endovascular IVC retrieval [8]. However, a systematic review revealed that 23.8% of patients (5/21) with duodenal perforation by an IVC filter had symptoms of gastrointestinal bleeding, and 66.7% of patients (14/21) underwent repair of the duodenum [3].…”

“…However, it has also been reported that an IVC filter placed for preventing PTE 1 month before surgery penetrated the IVC wall [13]. In that case, the IVC was exposed by mobilization of the duodenum under laparotomy, and the incised venous wall was repaired by suturing after retrieval of the filter via an endovascular approach [8]. A recent study has shown that IVC filter placement for 3 months did not reduce the rate of recurrent PTE in patients with DVT and PTE undergoing anticoagulant therapy [14].…”

“…Some reports have indicated that an IVC filter can be retrieved successfully using an endovascular approach in cases where a large hematoma around the duodenum or intra-abdominal adhesion due to a previous surgery precluded surgical retrieval [7, 8]. Although the endovascular approach is less invasive, other reports have documented cases in which endovascular IVC filter retrieval was unsuccessful [5, 6, 16].…”

Preparation and properties of a biodegradable inferior vena cava filter

“…Therefore, the implanting of temporary IVCF does not meet the requirement to reduce the risk of PE. To overcome the shortcomings of temporary IVCF, retrievable IVCF was produced …”