Migration of the fractured inferior vena cava filter strut to the right pulmonary artery successfully retrieved by a goo
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IMAGES IN CARDIOVASCULAR INTERVENTION
Migration of the fractured inferior vena cava filter strut to the right pulmonary artery successfully retrieved by a goose neck snare technique Yuki Sahashi1 · Toshiki Tanaka1 · Tatsuma Serge Yanagimoto1 · Hiroyuki Okura1 Received: 7 August 2019 / Accepted: 14 November 2019 © Japanese Association of Cardiovascular Intervention and Therapeutics 2019
Keywords Deep vein thrombosis · Inferior vena cava filter · Complications A 37-year-old woman with deep vein thrombosis (DVT) associated with pregnancy was hospitalized for left leg edema and pain at gestational week 30. Contrast-computed tomography (CT) scan revealed massive DVT in the left popliteal vein extending to the left common femoral vein and no evidence of pulmonary embolism. Deep vein thrombosis was treated with warfarin, considering that she was pregnant. An IVC filter (DENALI, BARD PERIPHERAL VASCULAR, INC, AZ, USA) was subsequently deployed at the suprarenal position to prevent fatal pulmonary embolism secondary to DVT. In the present case, because the patient was not able to visit our hospital due to personal reasons, removal of the IVC filter was postponed and, as a result, conducted 8 months after the index procedure. Removal of the IVC filter was performed 8th month after the placement from the right internal jugular vein. During this procedure, as the retrieval sheath covered the entire part of the IVC filter (Fig. 1a), a fractured IVC filter strut suddenly migrated to the right pulmonary artery (Fig. 1b). Migrated strut was successfully extracted by snare-loop technique (Microsnare AMPLATZ GOOSE NECK, Plymouth, MN, USA: Fig. 1c), using the 8-Fr right Judkins catheter from right jugular vein. No complications associated with neither strut removal nor
strut migration were observed. The entirety of the IVC filter as well as the migrated strut is shown in Fig. 1d. Retrospective review of the fluoroscopic images confirmed that the strut of the IVC filter had been fractured before the procedure (Fig. 1e). IVC filters are considered to be a viable option for preventing pulmonary embolisms secondary to DVT. Previous studies suggested the effectiveness of IVC filters for recurrent pulmonary embolism and pulmonary embolism related mortality [1, 2]. In the present case, prior to the filter removal procedure, the IVC filter strut fractured was unnoticed. The fact that, one filter arm was fractured, was only identified when this case was retrospectively reviewed. As a result, the filter arm was detached from the main body when the filter retrieval sheath covered the main body. Although the detailed mechanisms of filter arm fracture have not been elucidated yet, metal-fatigue due to long-term implantation could be considered in the present case. Further studies and case reports will be needed to investigate the best management of fractured IVC filter struts to prevent venous injury or strut migration.
* Yuki Sahashi [email protected] 1
Department of Cardiology, Gifu University, Graduate School of Medicine, 1‑1
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