Inferior vena cava filter penetration and anchor in the vertebral column

Penetration of Bone by Inferior Vena Cava Filters: Safety and Technical Success of Percutaneous Retrieval

PURPOSE

The technical success and safety of percutaneous inferior vena cava filters (IVCF) retrieval when filter elements are penetrating into adjacent bony structures is unknown. Therefore, our purpose was to evaluate the technical success and safety of IVCF retrieval when filter elements are penetrating into adjacent bone.

MATERIALS AND METHODS

Using percutaneous IVCF retrievals from 2008 to 2018 in adult patients, we conducted a multi-institutional, retrospective review of filters found to penetrate lumbar vertebrae by computed tomography scans. Technical success following the retrieval procedure was recorded. Patient records were assessed for complications from retrieval.

RESULTS

13 patients (2 males; 11 females; mean age: 53.2 years (range: 22-71) were included. Hundred percent of the filters were optional (retrievable) filters. Venous thromboembolism (VTE) with a contraindication to anticoagulation (n = 7; 53.8%) and prophylaxis without venous thromboembolism (n = 3; 23.1%) were the 2 most common indications for IVCF placement. Two filters (15.4%) had >15° of tilt relative to the IVC prior to retrieval while no IVCFs had migrated or caused caval thrombosis. One filter (7.7%) was found to have a fractured strut prior to retrieval. Ten patients (76.9%) were either on anticoagulants or antiplatelet medications at the time of retrieval. No patients were on antibiotics and no patients received periprocedural antibiotics. Median dwell time was 116.5 days (range: 49-5395). All 13 IVCFs were successfully retrieved in a single session (technical success: 100%). Standard snare technique was used in 8 cases (61.5%), endobronchial forces were used in 3 cases (23.1%), and wire loop snare technique was used in 2 cases (15.4%). There were no complications in any patient. Percutaneous retrieval of IVCFs with elements that have penetrated into adjacent vertebrae is both safe and technically feasible.

Percutaneous Retrieval of IVC Filters With Struts Penetrating the Vertebral Body

INTRODUCTION

Inferior vena cava (IVC) filter penetration of the caval wall is a well-documented complication. Less frequently, the struts of an IVC filter can penetrate a vertebral body that can lead to symptoms of abdominal pain. Vertebral penetration poses a management challenge, and characteristics for successful endovascular retrieval of such filters has not been reported.

CASE DESCRIPTION

We present 2 cases of IVC filters with vertebral body penetration that were successfully retrieved through an endovascular approach. On preprocedure computed tomography, both patients had a small zone of osteolysis surrounding the penetrated struts into the vertebral body. The procedures were done via right internal jugular access using an Ensnare device. In one of the cases, the hangman technique was used to release the filter apex from the vessel wall. Both filters were able to be retrieved without using excessive force, follow-up venacavograms showed no sign of extravasation, and no postprocedure complications developed.

DISCUSSION

Preprocedure CT imaging is essential prior to IVC filter removal if vertebral penetration is suspected. The zone of osteolysis seen around the struts in both cases are likely the result of constant cardiorespiratory motion of the filter. Based on the fact that in both cases the filter legs were able to be disengaged from the vertebral body without the use of excessive force, we hypothesize that if a zone of osteolysis surrounding the struts can be confirmed on preprocedural CT, the filter removal can be safely attempted by the standard percutaneous endovascular approach.