|Topic:||26. Physiology/Pathophysiology: Pulmonary Vascular and Right Ventricular Health and Disease / Adult / Case Report / Pulmonary Circulation (PC)|
|Authors:||B. Jalil, Y. Kothari, B. Al-Adili, K. El-Kersh; Louisville, KY/US|
Inferior Vena Cava filters (IVCFs) are occasionally used in the management of lower extremity deep venous thrombosis. Although many of these filters are retrievable, up to 30% of patients with IVCFs placed are lost to follow-up. In addition to the increased risk of venous thromboembolism, long-term complications of retained IVCFs include filter erosion and caval penetration, with organ involvement. We report a case of retained IVCF that resulted in penetration through the duodenum and lumbar vertebral body.
A 45-year-old female with past medical history of type 2 diabetes mellitus, deep vein thrombosis, and multiple abdominal surgeries secondary to a motor vehicle accident was admitted to the ICU for hyperosmolar hyperglycemic state. Abdominal tenderness prompted an abdominal computed tomography (CT) scan that showed an IVC filter with struts extending beyond the anatomical wall of IVC eroding into the third lumbar (L3) vertebral body (Fig.1-A). The patient underwent esophagogastroduodenoscopy (EGD) that revealed one of the IVCF struts eroding into the proximal duodenum (Fig.1-B). The patient had no evidence of any bowel obstructive symptoms or gastrointestinal bleeding. After extubation, the patient mentioned that she had an IVCF placed almost 8 years ago but she lost follow up after the filter placement. After a multidisciplinary consultation with interventional radiology and vascular surgery, surgical removal of the IVCF was deemed to be exceptionally high risk especially with her history of prior extensive abdominal surgeries. The patient had an uneventful hospital stay, and she was discharged home to follow up as an outpatient.
Limited penetration of IVCF struts into the caval wall is required to secure its position. This penetration is considered pathological when the filter struts extend beyond the IVC wall by more than 3 mm. Although asymptomatic filter penetration is common, penetration into multiple adjacent organs or structures is a rare complication. A recent literature review found only 20 cases of IVCF penetration with involvement of two adjacent organs/structures. (1) The duodenum was the most commonly involved structure followed by lumbar vertebrae and aorta. Treatment options include endovascular retrieval, open surgery, or conservative management with pain control and follow up imaging if filter retrieval is not possible.
1. Jia Z, Wu A, Tam M, Spain J, McKinney JM, Wang W. Caval Penetration by Inferior Vena Cava Filters: A Systematic Literature Review of Clinical Significance and Management. Circulation. 2015 Sep 8;132(10):944-52.