Duodenal Perforation by an IVC Filter: A Case and Discussion Expanding on the 2010 Guidelines for Filter Retrieval

Vyas, Ashish Kumar; Malas, Ahmad; Marshall, G Ryne; Harb, Ali; Stawick, Laurence; Svinarich, David M.

doi:10.1007/s00270-013-0754-4

Cited by 5 publications

(9 citation statements)

References 7 publications

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“… 10 – 12 While caval penetration is often identified as an incidental finding on imaging, it can cause serious complications including acute or chronic pain, hemodynamic instability, bowel perforation, and pancreatitis. 5 , 7 , 11 , 13 – 17 In our patient, persistent abdominal and back pain raised clinical suspicion for filter migration and extension outside the cava wall. CT and fluoroscopic imaging revealed nearly 90° filter tilt and extension of the filter apex through the wall of the cava with abutment of the duodenum, with the barbed filter prongs penetrating the caval wall, abutting retroperitoneal soft tissue structures and the aorta.…”

Section: Discussionmentioning

confidence: 68%

Total laparoscopic retrieval of inferior vena cava filter

Benrashid

Adkar

Bennett

et al. 2015

SAGE Open Medical Case Reports

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While there is some local variability in the use of inferior vena cava filters and there has been some evolution in the indications for filter placement over time, inferior vena cava filters remain a standard option for pulmonary embolism prophylaxis. Indications are clear in certain subpopulations of patients, particularly those with deep venous thrombosis and absolute contraindications to anticoagulation. There are, however, a variety of reported inferior vena cava filter complications in the short and long term, making retrieval of the filter desirable in most cases. Here, we present the case of a morbidly obese patient complaining of chronic abdominal pain after inferior vena cava filter placement and malposition of the filter with extensive protrusion outside the inferior vena cava. She underwent successful laparoscopic retrieval of her malpositioned inferior vena cava filters after failure of a conventional endovascular approach.

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Section: Discussionmentioning

confidence: 68%

Total laparoscopic retrieval of inferior vena cava filter

Benrashid

Adkar

Bennett

et al. 2015

SAGE Open Medical Case Reports

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“…IVC filters are a potentially important, but poorly evaluated, therapeutic modality in the prevention of pulmonary emboli [ 5 ]. IVC filters have been used since the early 1970s for the treatment of venous thromboembolic disease and retrievable IVF filters have been increasingly utilized since their introduction in 2001 [ 4 , 6 ]. Due to a lack of sufficient randomized controlled trials comparing various types of IVC filters, there is no ideal filter that is more efficacious or provides an improved safety profile over the other, though some situations do call for specific filters [ 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, a high clinical suspicion should be raised for patients with a history of IVC filter placement, if they complain of atypical or persistent abdominal pain, or had an episode of a gastrointestinal bleed. Diagnostic evaluation should include plain abdominal radiographs and CT scan is a valuable adjunct in the follow-up of IVC devices when a complication (especially IVC perforation) is suspected [ 4 , 10 ]. Excellent outcomes with low complication rates have been reported in cases where an open procedure was performed with either extraction of the filter or removal of the offending struts [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Strikingly, the number of cases of IVC perforating the duodenum reported in the literature has increased over the past 4 decades, and 25 cases were reported in a systematic review from 2012 [ 6 ]. This could be from widely available diagnostic modalities such as CT and EGD to aid in the diagnosis or the dramatically increased rate of IVC filter placement in the last few years, with almost 259,000 expected placements in the United States in 2012 according to the FDA [ 4 ]. Increasing incidence could also be because of a longer course required to produce the perforation.…”

Section: Discussionmentioning

confidence: 99%

“…These filters are generally safe but can cause several clinically significant, albeit rare, complications which have been infrequently reported in the literature [ 3 ]. Low retrieval rates have led to increased complications from short- and long-term filter placement; hence it is important to remove these filters as early as clinically indicated [ 3 , 4 ]. Breaching of the vena cava wall by an IVC filter is common, but usually asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

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IVC Filter Perforation through the Duodenum Found after Years of Abdominal Pain

et al. 2015

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Patient: Female, 67Final Diagnosis: IVC filter perforation through duodenumSymptoms: Abdominal painMedication: —Clinical Procedure: EsophagogastroduodenoscopySpecialty: Gastroenterology and HepatologyObjective:Challenging differential diagnosisBackground:The number of IVC filter-related complications has increased with their growing utilization; however, IVC filter perforation of the duodenum is rare. It can manifest with nonspecific abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction.Case Report:A 67-year-old female presented with several years of right upper quadrant abdominal pain which was exacerbated by movement and food intake. She had a history of hepatic steatosis, cholecystectomy, and multiple DVTs with inferior vena cava filter placement. Physical exam was unremarkable. Laboratory tests demonstrated elevated alkaline phosphatase and transaminases. Esophagogastroduodenoscopy revealed a thin metallic foreign body embedded in the duodenal wall and protruding into the duodenal lumen with surrounding erythema and edema, but no active hemorrhage. Further evaluation with non-contrast CT scan revealed that one of the prongs of her IVC filter had perforated through the vena cava wall into the adjacent duodenum. Exploratory laparotomy was required for removal of the IVC filter and repair of the vena cava and duodenum. Her post-operative course was uneventful.Conclusions:In patients with history of IVC filter placement with non-specific abdominal pain, a high clinical suspicion of IVC filter perforation of the duodenum should be raised, as diagnosis may be challenging. CT scan and EGD are valuable in the diagnosis. Excellent outcomes have been reported with open surgical filter removal. Low retrieval rates of IVC filters have led to increased complications; hence, early removal should be undertaken as clinically indicated.

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