Fractured Inferior Vena Cava Filter Strut Presenting with ST-Segment Elevation and Cardiac Tamponade

Abstract

The fracture of an inferior vena cava filter strut and its migration to the heart is a rare sequela of implanted inferior vena cava filters. Perforation I nferior vena cava (IVC) filters were first introduced in 1967, to prevent pulmonary embolism (PE) when anticoagulation is contraindicated or has failed in patients who have venous thromboembolic disease. In addition, IVC filters are used prophylactically in patients who have a high risk of PE. Implanted IVC filters are associated with such long-term sequelae as thrombotic occlusion of the IVC, vena cava perforation, and filter dislocation and migration. Inferior vena cava filter fracture has been reported in less than 1% of cases, 2 and the fracture of an IVC filter strut with its subsequent migration to the heart is apparently even less frequent. 3 We report the case of a man who presented with ST-segment elevation and cardiac tamponade after an IVC filter strut fractured, migrated, and perforated his right ventricle (RV). We also briefly review the relevant medical literature. Case ReportIn November 2010, a 53-year-old man presented at the emergency department 5 hours after the sudden onset of left-sided chest pain. His medical history included intracranial hemorrhage after head trauma 5 years earlier; afterwards, he had experienced seizures that were treated with antiepileptic medications. He had also had a Bard G2 ® retrievable IVC filter placed during his hospitalization for the intracranial hemorrhage; however, he did not report this to the physicians at the current admission. His vital signs on admission included a blood pressure of 90/56 mmHg, a heart rate of 101 beats/min, a respiration rate of 19 breaths/min, and an oxygen saturation of 98% on room air. An electrocardiogram showed sinus tachycardia at the rate of 117 beats/min and ST-segment elevation in the inferior leads.The patient was started on intravenous fluids and a dopamine infusion and was urgently taken to the cardiac catheterization laboratory. During angiography, the patient became hemodynamically unstable; his systolic blood pressure fell to 60 mmHg. Left-sided heart catheterization was performed through femoral access. The left main coronary artery was normal. There was an eccentric 70% stenosis in the proximal left anterior descending coronary artery (LAD) and a 60% stenosis in the mid-LAD. The first obtuse marginal branch was large and had an 80% stenosis. The ostial right coronary artery (RCA) had a 75% stenosis, and the mid RCA had a 70% stenosis. The patient's left ventricular ejection fraction (calculated by means of contrast ventriculography) was 0.70. During fluoroscopy, a small metal object was visible in the Case Reports

Cardiac arrest following retrieval of inferior vena cava filter: a case report and literature review of pericardial effusion and cardiac tamponade

“…To our knowledge, only four cases are reported; they are summarised in Table 1. We believe that our case is unique as it is the only reported incidence of cardiac arrest happening soon after the procedure of IVC filter retrieval [13][14][15][16] . Regardless of this, the primary goal in managing pericardial effusion and cardiac tamponade is to promptly relieve increased intrapericardial pressure and restore normal cardiac function.…”

Migrated Inferior Vena Cava (IVC) Filter Strut: A Rare Cause of Chronic Distal Pancreatitis with Likely Malignant Transformation

“…Fracture of the IVC strut occurs in 3.4% of patients who have had an IVC filter [ 5 ]. Different mechanisms [ 6 , 7 ] were proposed for the limb fracture, including tilting of the filter, continuous strain on the engaged strut, and metal fatigue. Migration of fractured IVC filter limb is occasionally reported, with an estimated incidence of 5% [ 5 ].…”

Extravascular Migration of a Fractured Inferior Vena Cava Filter Strut

“…Fractures of the IVCF strut occur in 3.4% of patients who have had an IVCF over the long term. The mechanism of fracture may be associated with tilting of the filter, continuous strain on the engaged strut, and metal fatigue [ 5 , 7 ]. If the fractured fragment migrates, it is usually found in the pulmonary arteries, iliac or femoral veins, right heart, or IVC near the filter.…”

“…Migration of the fragment can cause embolism, fatal arrhythmia, and cardiac wall injury. Even cardiac tamponade and sudden cardiac death due to migration of the fractured fragments of the IVCF have been reported [ 6 , 7 ]. If fracture of the IVCF strut is detected, close surveillance for the possibility of migration is required.…”