Greenfield filter caval perforation causing an aortic mural thrombus and femoral artery occlusion

Chintalapudi, Udaya; Gutierrez, Oscar H.; Azodo, Michael V.U.

doi:10.1002/(sici)1097-0304(199705)41:1<53::aid-ccd13>3.0.co;2-r

Cited by 23 publications

(11 citation statements)

References 9 publications

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“…7,14,15 Inferior vena cava penetration may be asymptomatic in most patients, 15 but some symptomatic patients 16 may require therapeutic intervention for duodenal perforation 11,[15][16][17] and aortic penetration. [18][19][20] Duodenocaval fistula may exceptionally occur in patients who have undergone IVC filter placement: a recent review of the literature 16 reported 37 cases, 10 of which were associated with an IVC filter. Duodenocaval fistula is usually a late complication, with an average of 6 years between filter placement and the occurrence of a fistula.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Late complication from a retrievable inferior vena cava filter with associated caval, aortic, and duodenal perforation: A case report

Veroux

Tallarita

Pennisi

2008

Journal of Vascular Surgery

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Inferior vena cava filters are an excellent therapeutic method for those patients in whom anticoagulant therapy is contraindicated or ineffective. However, filter placement is associated with a high rate of serious complications (>30%), with death occurring in 3.7% of patients. The most common complication is an asymptomatic inferior vena cava penetration and perforation. In some rare circumstances, however, therapeutic intervention may be required because of perforation of adjacent organs. We report a clinical case of a patient with simultaneous caval, duodenal, and aortic perforation resulting from penetration of inferior vena cava filter hooks. A brief review of the literature discusses presenting symptoms and treatment of such rare complications.

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Section: Discussionmentioning

confidence: 99%

“…12 A prompt diagnosis and surgical intervention is mandatory to achieve a better prognosis and a low mortality rate (10%). 16 Aortic perforation after IVC filter placement is exceptional 19 and may be associated with mural thrombus, 18 which may eventually cause a peripheral arterial occlusion.…”

Section: Discussionmentioning

confidence: 99%

Late complication from a retrievable inferior vena cava filter with associated caval, aortic, and duodenal perforation: A case report

Veroux

Tallarita

Pennisi

2008

Journal of Vascular Surgery

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“…In a case report, a 40-year-old man presented with a 4-month history of increasing upper abdominal pain, nausea, and a 40-pound weight loss [49]. Imaging included a negative ultrasound, although no mention of CT was made.…”

Section: Perforationmentioning

confidence: 99%

“…Complications vary and include aortic mural thrombus requiring aortotomy and thrombectomy [51]. Cases of IVC filter penetration causing aortic mural thrombus and femoral artery occlusion have also been reported [49]. Another exceedingly rare complication includes both aortocaval fistula and aortic pseudoaneurysm.…”

Section: Perforationmentioning

confidence: 99%

CT of inferior vena cava filters: normal presentations and potential complications

et al. 2015

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With massive pulmonary embolism (PE) being the first or second leading cause of unexpected death in adults, protection against PE is critical in appropriately selected patients. The use of inferior vena cava (IVC) filters has increased over the years, paralleling the increased detection of deep venous thrombosis (DVT) and PE by improved and more available imaging techniques. The use of IVC filters has become very common as an alternative and/or as a supplement to anticoagulation, and these filters are often seen on routine abdominal CT, including in the emergency setting; therefore, knowledge of the normal spectrum of findings of IVC filters by the radiologist on CT is critical. Additionally, CT can be used specifically to identify complications related to IVC filters, and CT may alternatively demonstrate IVC filter-related problems which are not specifically anticipated clinically. With multiple available IVC filters on the US market, and even more available outside of the USA, it is important for the emergency and the general radiologist to recognize the different models and various appearances and positioning on CT, as well as their potential complications. These complications may be related to venous access, but also include thrombosis related to the filter, filter migration and penetration, and problems associated with filter deployment. With the increasing number of inferior vena cava filters placed and their duration within patients increasing over time, it is critical for emergency and other radiologists to be aware of these findings on CT.

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“…Although these hooks will embed in the vessel wall, actual transmural penetration and entry to the pericaval space are uncommon (0.3%), 1 and secondary perforation of the aorta is exceedingly rare. 2,3 Filter-related IVC thrombosis is more frequent, estimated to occur in 2% to 10% of filter recipients. 4 Increased use of retrievable filters for temporary indications will likely reduce the incidence of delayed complications associated with permanent IVC interruption.…”

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confidence: 99%

Double Whammy

Sparrow

2011

Circulation

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A 72-year-old man was referred for computed tomography angiogram of his abdominal aorta for investigation of gradually worsening, now severe, intermittent claudication incurred at Ϸ10 yards. Risk factors for peripheral vascular disease included being a former smoker and hypertensive. His medical history included transurethral resection of his prostate 7 years previously, complicated by postoperative pulmonary emboli and delayed bleeding from the prostatectomy resection site. Given the latter, a Gunther-Tulip inferior vena cava (IVC) filter (Cook, Bloomington, IN) was inserted as protection against further pulmonary embolism while his anticoagulation was temporarily withheld.Contrast-enhanced computed tomography angiogram demonstrated mild fusiform aneurysmal dilatation of the infrarenal aorta with a maximum measurement of 4.2 cm, with thrombotic occlusion of the aorta immediately below the origin of his renal arteries. Within the area of aneurysmal dilatation, a metal strut of the previously placed filter was clearly visible within the aortic wall; this strut had perforated the IVC and eroded into the adjacent aorta (Figure 1). The IVC was itself thrombosed and atretic caudal of the point of perforation (Figure 2). The patient was asymptomatic in terms of his IVC thrombosis; he was subsequently referred for an axillary bifemoral bypass operation as treatment for his claudication.Practically all IVC filters currently in use have tethering hooks for device anchoring and prevention of migration. Although these hooks will embed in the vessel wall, actual transmural penetration and entry to the pericaval space are uncommon (0.3%), 1 and secondary perforation of the aorta is exceedingly rare. 2,3 Filter-related IVC thrombosis is more frequent, estimated to occur in 2% to 10% of filter recipients. 4 Increased use of retrievable filters for temporary indications will likely reduce the incidence of delayed complications associated with permanent IVC interruption. Thick-slab coronal maximum-intensity projection reformatted from the same study. Note the thin atretic thrombosed IVC caudal to the point of perforation (curved arrow). The entire infrarenal aorta is occluded from below the renal artery origins (straight arrow).

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Greenfield filter caval perforation causing an aortic mural thrombus and femoral artery occlusion

Cited by 23 publications

References 9 publications

Late complication from a retrievable inferior vena cava filter with associated caval, aortic, and duodenal perforation: A case report

Late complication from a retrievable inferior vena cava filter with associated caval, aortic, and duodenal perforation: A case report

CT of inferior vena cava filters: normal presentations and potential complications

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