Pulmonary thromboembolism exacerbated by thrombus migration through an inferior vena cava filter: a case report

TL;DR

A 61-year-old woman with pulmonary thromboembolism had a failed IVC filter, leading to further complications and requiring surgery.

Contribution

Highlights the risk of IVC filter tilt and advocates for advanced catheter-based treatments over surgery.

Findings

An IVC filter tilted, allowing thrombus migration and worsening PTE.

Surgical thrombectomy was required after catheter-based methods failed.

Advanced catheter-based devices may improve PTE treatment outcomes.

Abstract

Pulmonary thromboembolism (PTE) is a life-threatening condition requiring prompt and effective treatment. Current treatment options include anticoagulation therapy, catheter-directed therapies, and surgical interventions. While inferior vena cava (IVC) filters are widely used for PTE prophylaxis in high-bleeding-risk patients, their failure mechanisms and optimal alternatives remain understudied, particularly in intermediate-high-risk PTE cases where anticoagulation fails.

We present a case of intermediate-to-high-risk PTE in a 61-year-old woman who experienced recurrent embolization despite receiving anticoagulation therapy. Although an IVC filter was deployed to prevent further embolization, a thrombus from the superficial femoral vein migrated through the tilted IVC filter, and surgical thrombectomy was performed.

This case emphasizes the need for careful IVC filter placement to prevent tilt-related complications and supports the adoption of advanced catheter-based thrombectomy devices to enhance the efficacy of PTE treatment and reduce the need for surgical intervention.

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