Right Ventricular Migration of a Recovery IVC Filter’s Fractured Wire with Subsequent Pericardial Tamponade

Abstract

A Recovery filter (C.R. Bard, Tempe, AZ, USA) is a device for pulmonary embolism prophylaxis. There have been few case reports involving the migration of this particular filter or of a broken wire migrating to the heart. We report a case of right ventricular migration of a fractured wire from this filter in a patient who subsequently developed pericardial tamponade and required open heart surgery to extract the fractured wire. We discuss the current US Food and Drug Administration (FDA)-approved nonpermanent inferior vena cava filters and their reported complications. These complications can be life-threatening and may require immediate surgical intervention.

Percutaneous Extraction of Embolized Intracardiac Inferior Vena Cava Filter Struts Using Fused Intracardiac Ultrasound and Electroanatomic Mapping

“…The potential complications of cardiac tamponade and cardiac arrhythmias secondary to filter embolization to the myocardium can be devastating and were the primary reasons for deciding to remove the embolized filter struts (3,(5)(6)(7). In previous studies, filter fragments were successfully retrieved using either vascular snares or forceps (4,7,8).…”

“…The challenges of removing intracardiac foreign bodies are the spacious chamber sizes, cardiac trabeculations, destabilizing arrhythmias, cardiac and respiratory motion, fixed orientation of many sheaths, the need to retract the captured foreign body safely through delicate intracardiac structures such as valves, and avoiding a pericardial effusion (6,7). In obese patients, it can be difficult to fluoroscopically visualize small metal fragments with a background of moving soft tissues.…”

“…In particular, migration to the myocardium can result in cardiac tamponade and life-threatening arrhythmia (3,(5)(6)(7). In these rare cases, the patients went on to either open heart surgery (3,5,6) or percutaneous retrieval with snare devices (7,8) to recover the filter struts. Overcoming potential complications and the technical challenges in percutaneously retrieving intracardiac filter struts have not been previously addressed (7,8).…”

Retrieval of Recovery IVC Filter After 1,463-Day Implantation

“…The second study does identify penetration of the filter arms in 11 patients as a long-term concern, although the clinical significance is unknown; more troubling was the occurrence of arm fractures in three of these patients [5]. This is particularly demonstrated in the case of a patient who developed pericardial tamponade after right ventricular migration of a fractured filter arm, and required open heart surgery for correction [6]. However, several modifications have been made to the Recovery filter, including rounding of the bends in the neck region to reduce risk of fracture, and the revised version of this device, the G2 filter (Bard) is currently marketed [7].…”

Fracture Rate and Serious Complications of Vena Cava Filters

“…IVC filter strut fractures, although rarely reported in the literature, could potentially have fatal consequences, including embolization to the heart with subsequent right ventricle perforation or pericardial tamponade [8,9]. Nicholson et al reported a relatively high incidence of fracture with Bard Recovery (25%) and G2 filters (12%) at a mean of 37.8 months after implantation [6].…”