Intracardiac migration of nitinol TrapEase vena cava filter and paradoxical embolism

Inferior vena cava filter migration to the heart after stroke: a case report

This case report discusses the functional outcomes and multidisciplinary coordination of care for a patient with hemiplegia due to stroke complicated by a migrated inferior vena cava (IVC) filter embedded in the right side of the heart. The patient suffered an acute right-sided stroke with hemorrhagic transformation requiring hemicraniectomy with left hemiplegia. The patient developed a subsequent pulmonary embolism requiring IVC filter placement as anticoagulation was contraindicated due to risk of further intracranial hemorrhage. The IVC filter was later identified bridging the tricuspid valve, and surgical intervention was contraindicated requiring a coordinated plan to delay surgical removal of the filter in order to allow for optimization of the patient's functional and medical status. The patient underwent extensive telemetry monitoring in the intensive care unit to verify no significant cardiac arrhythmia developed with physical activity and was ultimately cleared for admission to acute inpatient rehabilitation. There was a well-coordinated effort between the cardiac, surgical, intensive care, and rehabilitation teams to transition to the inpatient rehabilitation facility to minimize risk and enhance recovery. The patient demonstrated functional improvement throughout rehabilitation and was discharged home with family with eventual surgical removal of the IVC filter. This case highlights the importance of collaboration across multiple disciplines to maximize patient rehabilitation and function, particularly in the context of atypical complications.

Urological complications caused by inferior vena cava filters: a systematic review

INTRODUCTION

Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review.

EVIDENCE ACQUISITION

A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication.

EVIDENCE SYNTHESIS

Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported.

CONCLUSIONS

Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.

Balloon catheter occlusion of the maxillary, internal, and external carotid arteries in standing horses

OBJECTIVE

To assess the feasibility of balloon catheter occlusion of the internal carotid artery (ICA), external carotid artery (ECA), and maxillary artery (MA) in standing horses.

STUDY DESIGN

Experimental and clinical cases series.

ANIMALS

Eight healthy horses (phase 1) and 11 clinical cases (phase 2).

METHODS

Occlusions were performed on standing horses under sedation and local anesthesia. In phase 1, four horses underwent bilateral ICA balloon catheter occlusion, and four horses underwent balloon catheter occlusion of the ECA and MA. In phase 2, horses were treated by occlusion of ICA (n = 7), ECA (n = 2), or ECA and ICA (n = 2).

RESULTS

Internal carotid artery occlusion was successful in seven of eight and seven of nine arteries in phases 1 and 2, respectively. The procedures lasted 53 and 50 minutes, respectively, and catheters were inserted over 13 ± 0.7 cm (mean ± SD). External carotid artery occlusion was successful in seven of seven and four of four arteries in phases 1 and 2, respectively, with mean durations of 31 and 26 minutes, respectively, and a mean distance of catheter insertion of 11.9 cm. Maxillary artery occlusion was successful in five of seven arteries (phase 1), with a mean surgical duration of 47 minutes and a mean distance of catheter insertion of 42.8 cm.

CONCLUSION

Balloon catheter occlusion of the ICA, ECA, and MA was achieved in most standing horses.

CLINICAL SIGNIFICANCE

Balloon catheter occlusion in standing horses provides an alternative to prevent or treat hemorrhage related to guttural pouch mycosis, particularly in horses in which general anesthesia might pose a risk.

Endovascular Retrieval of a Migrated TrapEase Inferior Vena Cava Filter From the Right Atrium: A Brief Report and Literature Review

Intracardiac migration is a rare complication of inferior vena cava filters (IVCFs) that poses a significant risk to patients. Both endovascular and surgical options exist, although only a few endovascular options are described in the literature. This brief report describes the endovascular approach used to successfully remove a TrapEase IVCF from the right atrium in a single patient. A brief review of the literature is also provided.

Cardiac Perforation by Migrated Fractured Strut of Inferior Vena Cava Filter Mimicking Acute Coronary Syndrome

We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.

Dual stent migration to the heart and pulmonary artery

The practice of intravascular stenting largely grew out of the concept of stenting the coronaries in acute myocardial infarction. According to the recent United States Renal Data System data registry, there has been a significant increase in endovascular intervention (1.8-fold increase-from 52,380 to 98,148) with a 2.2-fold increase in stent deployment in hemodialysis access (3792-8514). With the increasing use of endovascular stents in the management of dialysis access stenosis, the incidence of stent-related complications has increased significantly. Stent-related complications include stent restenosis, thrombosis (narrowing of the vessel lumen and being a nidus for thombus formation), stent shortening, stent fracture, stent infection, and stent migration. Physiologic variation in the diameter of veins due to respiration, which along with the geometry of the stent, can lead to a shortening lengthening of the stent-resulting in poor wall contact or high-speed impact of shock; in the case of trauma, mechanical bucking can result in tortuous blood vessels thereby resulting in stent migration (however proving this association was not the aim of this article). We report a case of a 44-year-old female with end-stage renal disease on hemodialysis, with stent placement to treat a compromised arteriovenous graft. There have been many cases of stent migration in the past; however, this is the first case of dual stent migration to the heart and pulmonary artery from an unusual (lower extremity) arteriovenous graft location.

Tips and tricks for retrieval of permanent TRAPEASE® filters for inferior vena cava

The placement of permanent inferior vena cava filters has definite indications and some filters have been shown to be more problematic in the long term than others. This report outlines the technique for TRAPEASE® filter removal in two patients. The first filter was retrieved four weeks after insertion and the second filter was retrieved 14 months after it was inserted at another institution. A planned approach for retrieval is described in these case reports.

Endovascular stent migration to the right ventricle causing myocardial injury

Central stenosis of the subclavian and internal jugular veins is common in end stage renal disease. Treatment of these stenoses is difficult as these veins respond poorly to angioplasty alone and often require metallic stents to ensure patency. These stents are not without complications. Reports of stent fracture, thrombosis and vessel rupture abound in the literature. Stent migration can occur when used in large central veins leading to severe consequences such as pulmonary infarction, tricuspid regurgitation and right sided heart failure. In this report, we report a case of a subclavian vein stent which migrated into the right heart and caused subendocardial injury. As the use of vascular stents is becoming a common treatment option for central venous stenosis, the occurrences of serious complications associated with the stents are likely to rise.

Sudden cardiac death caused by migration of a TrapEase inferior vena cava filter: case report and review of the literature

CASE

A 43-year-old female presented with sudden onset of palpitations, chest pain, and shortness of breath associated with hypoxemia. A helical computed tomography (CT) scan of the chest revealed a large saddle pulmonary embolism. Intravenous tPA relieved the shortness of breath and improved the hypoxemia. Inferior vena cava (IVC) filter (TrapEase, Cordis Corp., Miami, FL, USA) was placed. On day 6 of her hospitalization, she went into cardiopulmonary arrest while walking back from the rest room. The patient died despite a prolonged attempt at cardiopulmonary resuscitation. At that time, ventricular tachycardia and then ventricular fibrillation were recorded. Autopsy of the heart showed the IVC filter entrapped within the tricuspid valve.

DISCUSSION

The incidence of IVC filter migration ranges from 0.3 to 6% with rare migration to the heart or lung (0.1-1.25%). Sudden cardiac death from migration of IVC filter is extremely rare. We report the first case of sudden cardiac death caused by migration of the TrapEase filter to the heart. There are two reports in the literature of death from migrating Greenfield and Antheor filters.

CONCLUSION

An IVC filter migration to the heart, although rare, can cause serious arrhythmia and sudden cardiac death.

Emergency Retrieval of a G2 Filter after Complete Migration into the Right Ventricle

A G2 inferior vena cava filter migrated completely into the right ventricle, resulting in chest pain, ventricular tachycardia, and hypotension in a 63-year-old man. Due to the filter's position, the patient was at high risk for further life-threatening cardiopulmonary complications. Percutaneous filter retrieval was successfully performed as a less-invasive alternative to open cardiothoracic surgery.

Technical Error During Deployment Leads to Vena Cava Filter Migration and Massive Pulmonary Embolism

The Günther Tulip vena cava filter is a safe, effective, well-established device for pulmonary embolism prophylaxis. We report a patient in whom there was migration of the filter to the right atrium, 2 weeks after insertion, caused by a technical error during deployment. An attempt to retrieve the filter percutaneously failed, necessitating removal at open-heart surgery. The potential causes of migration are described and the lessons learned from this unusual case are outlined.

Complications of Abdominal and Pelvic Procedures: Computed Tomographic Diagnosis

The postprocedural period is a critical time in which serious complications can manifest. Localization of suspected complications following abdominal and pelvic procedures can be difficult on clinical evaluation alone. For example, abdominal pain after a colonoscopy may vary in etiology and can result from simple colonic spasm to colonic perforation, hemoperitoneum, or even splenic rupture. Vague abdominal pain following a renal biopsy may be due to minimal postprocedural bleeding into and around the kidney or may be due to potentially life-threatening hemorrhage. In such patients, computed tomography can play a crucial role in the rapid identification of complications as well guidance of subsequent patient management. The purpose of this article is to demonstrate the benefit of computed tomography-assisted diagnosis of complications associated with routine procedures performed on or throughout the abdomen and pelvis, including cardiac catheterization, colonoscopy, endoscopy, percutaneous biopsy, and interventional radiology procedures.

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

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.

TrapEase™ Vena Cava Filter: A Case of Filter Migration and Pulmonary Embolism After Placement

Inferior vena cava filters provide an alternative method of protection against pulmonary embolism in situations where anticoagulation either fails or is contraindicated. These filters are easily placed, with a relatively minor risk of complications. Currently, we know of only one reported case of filter migration using the TrapEase filter. We present a case report of a migrating TrapEase filter, as well as pulmonary embolism after TrapEase filter placement. This complication developed in a 31-year-old trauma patient who developed bilateral popliteal deep vein thromboses and an initial pulmonary embolus while on low molecular weight heparin.

Vena Cava Filters: Uses and Abuses

Currently, there are more than 10 permanent and optional retrievable vena cava filters in use in North America and Europe. Indications for inferior vena cava (IVC) filter placement are intuitive and filters are used in patients who have deep venous thrombosis (DVT) and contraindications to anticoagulation, or in patients who hemorrhage while anticoagulated for DVT. Multiple studies have proposed broadening the use of IVC filters as primary venous thromboembolism (VTE) prophylaxis in certain patient populations. Many permanent IVC filters have been well studied and have superior performance characteristics. On the other hand, optional retrievable IVC filters are attractive in the patient with a well-defined, short-term risk for VTE and contraindications to anticoagulation. Filter retrieval after the patient can be anticoagulated would eliminate the long-term risk of DVT associated with permanent IVC filter placement. Unfortunately, most optional retrievable filters are relatively new and have little to no data on their long-term performance when used as permanent filters, and the percentage of retrievable filters actually removed is less than 50%. The spirited debate concerning which patient should get which filter is just beginning. More prospective, randomized trials evaluating optional retrievable filters are needed to answer these important questions.

Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism

BACKGROUND

Venous thromboembolic (VTE) disease remains a significant cause of morbidity for trauma patients because many patients have injuries that may preclude effective VTE prevention and treatment. Retrievable vena cava filters may prove beneficial in this subset of trauma patients.

METHODS

Trauma patients at risk for VTE were identified and managed by institutional protocol. Patients who required a vena cava filter were managed with a device that could be retrieved or left in situ. A retrospective review of medical records was used to identify the use, indications, and complications associated with a retrievable filter.

RESULTS

Fifty-three retrievable filters were placed in 51 patients. Two of these patients received a second filter, and 1 received a filter in the superior vena cava. Thirty-two filters were placed prophylactically, whereas 21 were placed for demonstrated venous thromboembolism (VTE). Retrieval was successful in 24 of 25 attempts. Twenty-nine filters became permanent: 10 for continued contraindications to anticoagulation without known VTE, 12 for known VTE and continued contraindications to anticoagulation, 1 for technical reasons, and 6 because of patient death. There were no complications of bleeding, device migration or thrombosis, infection, or pulmonary embolism.

CONCLUSIONS

A retrievable vena cava filter appears safe and effective for the prevention of pulmonary embolism in the high-risk trauma patient who cannot receive anticoagulation.

Right Atrial Migration and Percutaneous Retrieval of a Günther Tulip Inferior Vena Cava Filter

This report describes a 67-year-old trauma victim in whom a retrievable Günther Tulip (Cook, Bloomington, IN) inferior vena cava filter was placed. The filter migrated to the right atrium immediately after placement. Initial attempts to retrieve the filter with Amplatz Goose Neck snares (Microvena, White Bear Lake, MN) were unsuccessful. A second attempt performed a week later with the addition of the new EnSnare (MDTech, Gainesville, FL) was successful. Possible causes of the migration are discussed and the difficulties encountered while removing this retrievable filter are described.