Misplaced Inferior Vena Caval Filter in Right Renal Vein with Erosion into Renal Collecting System

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.

Open retrieval management of inferior vena cava filter erosion resulting in symptomatic hydroureteronephrosis

Inferior vena cava filters are effective for the management of thromboembolic disease but can erode into adjacent organ systems in rare instances. Endovascular retrieval of eroded filters has been the preferred management for this complication. We present a case for which endovascular retrieval was not appropriate because of filter orientation and erosion into the ureter and describe successful management using open retrieval of a permanent filter with erosion into the renal collecting system requiring reconstruction. Although minimally invasive retrieval is preferred over open repair, this approach should be considered when filter erosion is not amenable to endovascular retrieval.

Search and Rescue: A Case Report and Discussion of Iatrogenic Intravascular Foreign Bodies

The following case report demonstrates an unusual case of a patient with multiple intravascular iatrogenic foreign bodies. An inferior vena cava filter was identified in the abdominal aorta, and multiple hydrophilic wire fragments were found in the pulmonary circulation. After describing the management of this patient, we discuss how radiologists can best distinguish between various intravascular iatrogenic foreign bodies. Determining the type of catheter or wire within the patient can not only establish the chronicity of the finding, but can determine whether or not endovascular retrieval is recommended, and by what method. It is of the utmost importance that providers be able to distinguish between various intravascular devices in order to prevent ongoing or further harm to the patient.

Open retrieval of an inferior vena cava filter penetrating into a horseshoe kidney

Retrievable inferior vena cava filters carry a risk of penetrating into adjacent structures, which may necessitate open retrieval. We report a unique case of a retrievable inferior vena cava filter penetrating into an overlying horseshoe kidney, leading to clinical hematuria. After repeated failed endovascular retrieval, an open approach with associated access challenges was required.

Trauma Admission CT as a Road Map for IVC Filters

The objective of this study was to determine if admission abdominal/pelvic CT on trauma patients can be used as a novel method to evaluate the inferior vena cava (IVC) anatomy and facilitate potential IVC filter placement. Consecutive trauma admission CT's were reviewed. The potential landing zone for filters was determined by the IVC mid portion between the renal and iliac veins. The IVC landmarks were described anatomically using the thoracic and lumbar vertebral bodies as reference points. The IVC diameter and anatomic anomalies which would affect filter placement were also evaluated from the CT. The records of 610 Trauma patients were reviewed. There were 518 (84.9%) that had an admission CT, forming the basis of the study. The CT for 500 of 518 (96.5%) was of sufficient quality to accurately evaluate the IVC. The third lumbar location of the IVC was a safe landing zone in 476 of 500 (95.2%). Anatomic anomalies were present in 47 of 500 (9.4%). We had the following three conclusions. The admission CT in over 96% of trauma patients can be used to determine the IVC filter landing zone. The third lumbar region of the IVC was a safe landing zone in over 95%. Anatomical anomalies affecting IVC filter placement were revealed in 9.4%.

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.