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

Veroux, Massimiliano; Tallarita, Tiziano; Pennisi, Monica

doi:10.1016/j.jvs.2008.02.002

Cited by 47 publications

(39 citation statements)

References 20 publications

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“…33,34 For cases in which the filter is not removed, follow-up CT scans are appropriate. 35 Removal of permanent filters such as Greenfield, VenaTech, and Bird's Nest filters is technically challenging because these filters are not designed to be retrieved. Although surgical filter retrieval has been reported, 36 conservative management including observation and analgesia is the usual management for non-life-threatening penetrations.…”

Section: -13mentioning

confidence: 99%

Caval Penetration by Inferior Vena Cava Filters

et al. 2015

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Background-Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters. Methods and Results-The MEDLINE database was searched for all studies showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications. Conclusions-Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement.Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.

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Section: -13mentioning

confidence: 99%

Caval Penetration by Inferior Vena Cava Filters

et al. 2015

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“…The patient underwent endoscopy, which revealed a non-hemorrhagic erosion within the proximal duodenum, with swelling associated with a metallic foreign body, a strut of the patient's Bird's Nest IVC filter [50]. Additional cases of IVC filter perforation of the duodenum have been reported [51]. In a review of the literature, of 37 reported cases of duodenocaval fistulas, 10 were associated with an IVC filter [51], although duodenal perforations are usually asymptomatic [50].…”

Section: Perforationmentioning

confidence: 99%

“…Additional cases of IVC filter perforation of the duodenum have been reported [51]. In a review of the literature, of 37 reported cases of duodenocaval fistulas, 10 were associated with an IVC filter [51], although duodenal perforations are usually asymptomatic [50]. Fig.…”

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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“…Factors such as route and technique, indication for placement, category/ size of filter and timing of retrievable filters should also be taken into consideration to decrease rate of complications. Complications of IVC filters are numerous pulmonary embolism, duodenal and aortic perforations, caval thrombosis, post thrombotic syndrome, migration to right atrium, right ventricle and pulmonary artery and should not be ignored [1,4]. Less than 30 cases of IVC filter fracture with cardiac migration has been reported in the literature [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Delayed complication of a retrievable inferior vena cava filter

Patel¹,

Tong²,

Nautiyal³

et al. 2017

Vascul Dis Ther

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40 year old female with history of hypertension, hyperlipidemia, atrial fibrillation and gastric bypass surgery six years ago with perioperative placement of Bard IVC filter at an outside institution presented with sudden onset, sharp, unrelenting chest pain and dyspnea on exertion. Her peak troponin was elevated with nonspecific ST and T wave changes on her electrocardiogram. She underwent left heart cardiac catheterization which was negative for coronary occlusions however fluoroscopy did demonstrate a foreign body in left lower distal branch of pulmonary artery and right ventricle. CT scan confirmed a presence of a linear metallic radio-opaque foreign body within the right ventricle extending into adjacent pericardial fat (Figure 1). Transthoracic echocardiogram confirmed the foreign body embedded in the right ventricle with extension into the pericardial space ( Figure 2). Open heart approach was selected versus endovascular approach due to penetrating nature of the object as suggested on CT scan. A subxiphoid approach was used to create a pericardial window and pericardium was identified with bloody pericardial fluid. There was no evidence of foreign body penetrating through the ventricle as initially suggested by CT scan. Procedure was converted to median sternotomy for better visualization. There was no evidence of extracardiac foreign body penetrating through the surface of the heart upon palpation of surface. Ascending aorta, inferior vena cava and superior vena cava were cannulated and cardiopulmonary bypass was initiated. Right atrium was opened and tricuspid valve was elevated out to visualize the right ventricle. A metallic object was found penetrating into the right ventricular free wall. She underwent extraction of the sharp metallic object (3.0cm x less than 0.1cm x less than 0.1cm) embedded in the right ventricle and percutaneous IVC filter retrieval (Figures 3 and 4).Her postoperative course was uncomplicated and she was discharged home with sternal wound healing precautions. DiscussionRetrievable Vena Cava Filters are Food and Drug Administration (FDA) approved for pulmonary embolism prophylaxis and is only recommended in patients' who have an absolute contraindication to anticoagulation (Grade 1a). Retrievable IVC filters were designed to provide temporary protection from pulmonary embolism [1,2], however about 50% of the these implantations are not retrieved. In another single center retrospective study, of 679 IVC filters placements, only 8.5% were successfully removed and rate of filter fracture was found to be unusually high as 40% at 5.5 years [3].Venous thromboembolic disease remains a major cause of morbidity and mortality. Familiarity with complications of IVC filter

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

Cited by 47 publications

References 20 publications

Caval Penetration by Inferior Vena Cava Filters

Caval Penetration by Inferior Vena Cava Filters

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

Delayed complication of a retrievable inferior vena cava filter

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