Symptomatic inferior vena cava perforation by a retrievable filter: Report of two cases and a literature review

Perforation of inferior vena cava and duodenum by strut of inferior vena cava filter: A case report

INTRODUCTION

An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term.

PATIENT CONCERNS AND DIAGNOSIS

A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts.

INTERVENTIONS

We performed a laparotomy to remove the IVC filter.

OUTCOMES

Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge.

LESSONS

There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.

Symptomatic duodenal perforation by inferior vena cava filter

Objectives

Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments.

Method

The reference list of Malgor’s review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde.

Results

Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative.

Conclusion

Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.

Gross haematuria associated with penetration of an inferior vena cava filter into the right renal collecting system

Inferior vena cava (IVC) filters are a viable alternative for patients with venous thromboembolic disease for whom standard anticoagulation therapy is contraindicated. Rare complications associated with their use, however, include misplacement and IVC penetration. We report a case of a 63-year-old woman who developed gross haematuria following IVC filter penetration into both the right renal collecting system and renal pelvis, for which open caval removal and reconstruction was required. This is an unusual case of IVC filter penetration causing symptomatic haematuria and requiring surgical intervention.

Infusion of iodine-based contrast agents into poly(p-dioxanone) as a radiopaque resorbable IVC filter

To determine the feasibility of infusing resorbable inferior vena cava (IVC) filter with iodine-based contrast agents to produce a radiopaque, computed tomography (CT)-visible IVC filter. Infused poly(p-dioxanone) (PPDO) was obtained by incubating PPDO in different concentrations of 4-iodobenzoyl chloride (IBC) and 2,3,5-triiodobenzoic acid (TIBA). Characterizations of infused and nascent PPDO were done using elemental analysis, micro-CT, tensile strength analysis, scanning electron microscopy, and differential scanning calorimetry. Elemental analysis showed percentage loading of 1.07 ± 0.08 for IBC and 0.73 ± 0.01 for TIBA. The iodine loading remained the same within 2 weeks for TIBA but decreased to about 80 % with IBC when subjected to physiological conditions. Micro-CT images showed increased attenuation of the infused PPDO compared with the nascent PPDO. The Hounsfield unit values for infused and nascent sutures were 110 ± 40 and 153 ± 53 for PPDO infused with 2 mg/mL IBC and TIBA, respectively, but only 11.35 ± 2 for nascent PPDO. In contrast the HU for bone was 116 ± 37. Tensile strength analysis showed maximum loads of 1.01 ± 0.43 kg and 10.02 ± 0.54 kg for IBC and TIBA, respectively, and 10.10 ± 0.64 kg for nascent PPDO. Scanning electron microscopy showed that the morphology of the PPDO surface did not change after coating and preliminary cytotoxicity assay showed no killing effect on Hela cells. PPDO infused with a contrast agent is significantly more radiopaque than nascent PPDO on micro-CT imaging. This radiopacity could allow the position and integrity of infused resorbable IVC filter to be monitored while it is in place, thus increasing its safety and efficacy as a medical device.

Retrievable inferior vena cava filters for venous thromboembolism

Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability.