Perforated inferior vena cava filters as the cause of unclear abdominal pain.

Inferior vena cava filters are considered a valuable therapeutic option in patients with deep vein thrombosis, subsequent pulmonary emboli, and contraindication for anticoagulation. However, these filters bear the risk of rare but serious complications (e.g., symptomatic caval perforation). We report our experiences with retrievable vena cava filters by means of an actual case and review the recent literature with special regard to filter-dependent delayed symptomatic vena cava perforations. Here, an inferior vena cava filter could be identified as the source of a patient's abdominal pain; after an interventional retrieval approach had failed, open surgical removal became necessary and led to the instant relief of this patient's symptoms. Retrievable vena cava filter removal should be performed in all cases as soon as no longer needed to avoid fatal complications.

Meyer A ，Schönleben F ，Heinz M ，Lang W ... -  《-》

Perforation of inferior vena cava during filter placement.

Piecuch J ，Wiewiora M ，Nowowiejska-Wiewiora A ，Szkodzinski J ，Polonski L ... -  《Vasa-European Journal of Vascular Medicine》

Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall.

To examine the feasibility and safety of removing retrievable inferior vena cava (IVC) filters with struts external to the IVC wall on computed tomography (CT) imaging. This retrospective study included 64 IVC filter retrievals from 62 patients over a 5-year period. CT images obtained before retrieval were used to describe the various imaging characteristics of filter interactions with the IVC wall. Patient medical records were reviewed for filter type, results of filter removal with standard or nonstandard techniques, and complications. Filter struts outside the IVC wall were a common finding on CT with 55 (85.9%) filters showing some degree of perforation. Of 64 filters, 57 (89.1%) were removed successfully; 7 (10.9%) filters could not be removed because of incorporation of filter struts or tip into the IVC wall. Before retrieval, filter fracture was detected in eight (12.5%) cases, and IVC stenosis was present in three (4.7%) cases. No major complications occurred during any retrieval. Two (3.1%) cases were complicated by postprocedure abdominal pain. Both cases clinically resolved, and no abnormalities were detected on postprocedure CT. The appearance of filter struts tenting or penetrating the IVC wall is a common finding on CT performed before filter retrieval. IVC filters with these findings can be removed safely and should not be a contraindication for IVC filter retrieval.

Oh JC ，Trerotola SO ，Dagli M ，Shlansky-Goldberg RD ，Soulen MC ，Itkin M ，Mondschein J ，Solomon J ，Stavropoulos SW ... -  《-》

Surgical Management of Perforated Inferior Vena Cava Filters.

Management of complicated indwelling inferior vena cava (IVC) filters has increased due to low retrieval rates. Filter migration and perforation are infrequent complications and require explantation of the filter. We report our recent experience with endovascular retrieval and surgical explantation of IVC filters after caval perforation. This is a retrospective review of patients who had IVC filter explantation between 2014 and 2015. Patient demographics, indication for filter placement, clinical presentation, surgical indication and technique, and outcomes were noted. Five cases of IVC filter removal due to caval perforation were identified. Four patients were female, and the median age was 50. Four IVC filters were of the retrievable type and had an average indwelling time of 4 years. One filter was permanent with an indwelling time of 9 years. The most common presentation was abdominal pain. Four patients had an open operation: 2 performed via laparotomy and 2 with retroperitoneal exposure of the IVC. One patient required median sternotomy and explantation of device fragments that migrated to the right ventricle. One patient had endovascular retrieval, with filter indwelling time of 0.8 years. No mortality occurred related to device removal. All patients had resolution of pain at their postoperative visit. Patients presenting with abdominal pain and history of IVC filter placement should cause concern for possible caval strut perforation. Endovascular retrieval or surgical explantation are required for removal and can be accomplished with minimal risk to the patient.

Manzur M ，Ochoa C ，Ham SW ，Lee W ，Simcox T ，Rowe V ，Weaver F ... -  《-》

Complications of inferior vena cava filters.

With the introduction of retrievable inferior vena cava filters, the number being placed for protection from pulmonary embolism is steadily increasing. Despite this increased usage, the true incidence of complications associated with inferior vena cava filters is unknown. This article reviews the known complications associated with these filters and suggests recommendations and techniques for inferior vena cava filter removal.

Sella DM ，Oldenburg WA 《-》