Surgical removal of an inferior vena cava filter with duodenal penetration.

Complications due to long-term implantation of inferior vena cava (IVC) filters have increased. Among these, IVC wall penetration by struts can lead to penetration of adjacent structures, which can be fatal to the patient. Herein, we report a case of a 63-year-old woman who underwent surgical removal of an IVC filter with duodenal penetration. Oesophagogastroduodenoscopy findings revealed a strut in the duodenal second portion. The IVC filter was inserted 19 months ago but had not been retrieved. On admission, computed tomography showed malposition of the IVC filter with penetration of duodenum by an anterior strut. Therefore, we performed surgical removal of the IVC filter. After surgery, her postoperative course was uneventful.

Lee JS ，Hwang JK ，Park SC ，Kim SD ... -  《-》

Filter-Associated Inferior Vena Cava Thrombosis with Duodenal Perforation: Case Report and Literature Review.

The aim of this article is to report a case of filter-associated inferior vena cava (IVC) thrombosis with perforation of the duodenum and penetration of a vertebral body by the filter struts. A 37-year-old woman with a medical history of Behcet's disease treated with corticosteroids underwent placement of a retrievable IVC filter because of recurrent iliofemoral venous thrombosis regardless of therapeutic levels of anticoagulation. Despite a correct positioning of the filter, the second follow-up computed tomography scan, performed at 1 year, showed a complete thrombosis of the infrarenal IVC segment, with perforation of the vessel wall by the filter struts and penetration in the duodenum. The patient remained asymptomatic. Open surgical removal of the filter with resection of the affected vena cava without vascular reconstruction was planned. The operation was performed under general anesthesia, surgical exposure was performed through a small midline laparotomy, and a duodenal Kocher maneuver was then performed to expose the IVC. The filter struts were found to have completely passed the cava wall in multiple directions. 2 struts penetrated through the duodenal serosa and 1 strut was embedded in the L3 periosteum. The IVC filter was successfully removed en bloc with the segment of the thrombosed and retracted IVC. The stumps were closed with 3-0 running polypropylene sutures and the duodenal lesions were closed with vicryl seromuscular sutures. No vascular reconstruction was necessary due to the marked development of collateral venous circulation. The patient was discharged home on postoperative day 6 and is doing well 6 months after surgery. Patients with IVC penetration of filter struts are usually asymptomatic, as was our patient. However, a high level of clinical suspicion for perforation should be maintained when facing nonspecific abdominal or back pain, and in episodes of gastrointestinal bleeding in patients with an IVC filter. We recommend that patients with implanted IVC filters, even those who are asymptomatic, should receive regular imaging follow-up, and retrievable filters should be removed as soon as they are no longer needed.

Chassin-Trubert L ，Prouse G ，Ozdemir BA ，Lounes Y ，Alonso W ，Clapiès M ，Alric P ，Canaud L ... -  《-》

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

Park HO ，Choi JY ，Jang IS ，Kim JD ，Kim JW ，Byun JH ，Kim SH ，Yang JH ，Moon SH ，Kim KN ，Kang DH ，Jung JJ ，Choi SM ，Kim JY ，Lee CE ... -  《-》

Persistent abdominal pain caused by an inferior vena cava filter protruding into the duodenum and the aortic wall.

Inferior vena cava (IVC) filter placement has increased dramatically over the past 2 decades. Symptomatic duodenal perforation by IVC filters with involvement of the aorta is a very rare, but challenging, complication. We report a case of persistent atypical right upper quadrant pain secondary to duodenal and aortic perforation by an IVC filter treated with cavotomy for filter removal, primary repair of the duodenum, and extraction of prongs from the aorta.

Malgor RD ，Hines GL ，Terrana L ，Labropoulos N ... -  《-》

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 ... -  《-》