Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac Tamponade

Abstract

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.

Trombosis bilateral de venas renales e insuficiencia renal aguda secundaria a trombosis de un filtro en vena cava inferior

“…En otra serie de 400 pacientes la trombosis de VCI se observó en 4,7% de ellos 12 . Otra de las complicaciones que pueden ocurrir es la migración del filtro y oclusión del ostium de alguna rama venosa con obstrucción de la misma, lo que no ocurrió en nuestro paciente 19 . Este paciente presentó una trombosis aguda de la VCI, bajo un filtro instalado en una posición superior a los riñones, con extensión de la trom-bosis a ambas venas renales.…”

Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart: a case report

“…There is a paucity of studies addressing the optimal management of patients with migrating struts from fractured IVC filters. A review of the literature revealed only eight case reports [2][3][4][5][6][7][8][9] clearly documenting IVC filter fragment migration to the right ventricle. A variety of treatment options ranging from conservative pain management to endovascular or open surgical extraction of the migrating struts have been suggested.…”

Inferior Vena Cava Filters: Two Years Experience in King Abdulaziz University Hospital

“…The risk of complications could be either during its insertion, e.g. penetration of the IVC) [13] , penetration to the aortic lumen or vertebral body [14] , or occlusion after insertion by filter thrombus [12] , migration of the filter in a whole [15][16][17][18][19][20][21] or in part in the form an embolus of fractured part [22] .…”

“…Even rupture of the tricuspid valve [17] , rupture of the free wall of the right ventricle [18] , and cardiac tamponade [19] , that might cause sudden death [20] . Also, migration to the pulmonary artery [21] , fracture and embolization leading to cardiac tamponade had been documented [22] . Moreover, tilting of the filter was also reported [23] .…”