Lumbar artery pseudoaneurysm in a patient with inferior vena cava filter and history of strenuous physical exercise

Massive Pulmonary Embolism due to Inferior Vena Cava Thrombosis Related to Compression by Lumbar Artery Pseudoaneurysm. A Case Report and Review of Literature

Lumbar artery pseudoaneurysm (LAPA) is a pathology infrequently described in the literature. The most frequent complications are the expansion and rupture of the pseudoaneurysm. Reports of association between PE with LAPA have not yet been described. We present a 53-year-old male patient with LAPA whose expansion caused compression of the inferior vena cava and subsequently PE. He underwent mechanical thrombectomy and inferior cava vein filter placement associated with embolization of the LAPA. Despite the severe clinical profile, the patient was discharged with a favorable postoperative course without complications. This case report also includes a review of the literature.

Caval Penetration by Inferior Vena Cava Filters

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 (1970–2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) 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.