Open Surgical Retrieval of a Perforated Inferior Vena Cava Filter: A Case Report

TL;DR

A case report describes the surgical removal of a perforated IVC filter after 1.5 years of implantation due to risks of aortic injury.

Contribution

This case highlights the challenges and successful open surgical retrieval of a perforated IVC filter.

Findings

IVC filter perforation occurred after 1.5 years of implantation, necessitating surgical intervention.

Anticoagulation therapy with edoxaban led to thrombus lysis and recanalization.

Open surgical retrieval was performed without aortic injury and with a stable postoperative recovery.

Abstract

Inferior vena cava (IVC) filters are used to prevent fatal pulmonary embolism (PE) and may be associated with late-stage complications as filter hooks may deviate over time. Prolonged implantation and challenges in retrieving these filters can lead to damage to the surrounding organs. In this report, we described a case in which a thrombus in the IVC filter made retrieval difficult. Following 1.5 years of implantation, the IVC filter had perforated, necessitating surgical retrieval due to the risk of aortic injury.

A 56-year-old woman presented with right lower extremity venous thrombosis and asymptomatic PE; anticoagulation therapy with edoxaban 60 mg once daily was started after the placement of an IVC filter. On the 10th day, computed tomography (CT) imaging revealed the development of venous thrombosis leading to thrombosis and occlusion of the IVC, which complicated filter retrieval. CT findings 1.5 years post-placement showed thrombus lysis and recanalization due to anticoagulation therapy with edoxaban 60 mg once daily. The patient was asymptomatic. However, filter perforation outside the IVC was observed, with one of the six perforated filter hooks located proximally to the abdominal aorta, raising concerns of potential aortic injury. Open surgical retrieval of the perforated IVC was performed under general anesthesia, with no evidence of aortic injury. The perforated hook was retrieved from outside the IVC, followed by a retrieval of the remaining filter body through venotomy. The patient's postoperative condition was stable; she was discharged without complications, and anticoagulation therapy with edoxaban 60 mg once daily was continued for six months postoperatively.

IVC filter perforation is a common late complication associated with filter use. Currently, no clear consensus exists regarding these treatment strategies, and further research and case studies are warranted.

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