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Int J Angiol
DOI: 10.1055/s-0041-1730451
Case Report

Right Ventricle Embolization of IVC Filter Fragments: An Incidental Finding

Santiago J. Miyara    a
1   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
,
Sara Guevara   a
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
,
Linda Shore-Lesserson   a
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
,
Muhammad Shoaib
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Claudia Kirsch
7   Department of Radiology, North Shore University Hospital, Manhasset, New York, New York
,
Christine N. Metz
1   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
,
Vinay Nair
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
8   Department of Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Lawrence Lau
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
,
Rishabh C. Choudhary
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Alexia McCann-Molmenti
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Anthony M. Baez
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
,
Kei Hayashida
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Ryosuke Takegawa
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Koichiro Shinozaki
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Tomoaki Aoki
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Mitsuaki Nishikimi
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Young Min Cho
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
,
Alexis Morell
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
,
Stefanos Zafeiropoulos
1   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
,
Stavros Zanos
1   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
,
Stacey Watt
9   Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, New York
,
Lisandro Montorfano
10   Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
,
Cristian D. Bartoc
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
,
Claudio M. Lumermann
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
,
Judith Aronsohn
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
,
Lance B. Becker
1   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
2   Feinstein Institutes for Medical Research, Manhasset, New York, New York
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
4   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
,
Ernesto P. Molmenti
3   Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
› Author Affiliations Funding No funding was involved in this publication.
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Abstract

This case report describes a 52-year-old male patient, with the incidental finding of inferior vena cava filter (IVCF) fragments impacted into the right ventricle, secondary to IVCF fragmentation and subsequent embolization. While IVCFs are prescribed to prevent pulmonary embolizations when anticoagulation is either contraindicated, or has failed, IVCF embolizations to the heart represent an extremely rare, but potentially life-threatening complication. Of note, at the time of writing, the utility and effectiveness of IVCF are not fully established. Intracardiac embolizations of IVCF typically present with complications such as hypotension, cardiac tamponade, arrhythmias, ventricle perforation, bleeding, cardiac arrest, and death. To our knowledge, this is the first case report of an asymptomatic kidney transplant recipient found to have right ventricle embolizations of IVCF fragments through routine assessment. Additionally, this is also the first report of an asymptomatic patient who presented IVCF fragments embolized to the right ventricle and left gonadal vein in the same clinical setting.

Keywords

IVCFs - intracardiac embolization - thrombosis - thromboembolic disease - DVT - IVCF migration - pulmonary embolism - incidental finding

a These authors had equal contribution.




Publication History

Received: 01 February 2021

Accepted: 08 March 2021

Article published online:
30 July 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Young T, Sriram KB. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev 2020; 10: CD006212 . Published 2020 Oct 8. doi:10.1002/14651858.CD006212.pub5
    PubMedGoogle Scholar
  • 2 Bick RL. Hereditary and acquired thrombophilia. Part I. Preface. Semin Thromb Hemost 1999; 25 (03) 251-253
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Van Ha TG. Complications of inferior vena caval filters. Semin Intervent Radiol 2006; 23 (02) 150-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Kaufman JA, Barnes GD, Chaer RA. et al. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol 2020; 31 (10) 1529-1544
    CrossrefPubMedGoogle Scholar
  • 5 Turner TE, Saeed MJ, Novak E, Brown DL. Association of Inferior Vena Cava Filter Placement for Venous Thromboembolic Disease and a Contraindication to Anticoagulation With 30-Day Mortality. JAMA Netw Open 2018; 1 (03) e180452
    CrossrefPubMedGoogle Scholar
  • 6 Secemsky EA, Carroll BJ, Yeh RW. Inferior vena cava filters and mortality: is it the underlying process, the patient, or the device?. JAMA Netw Open 2018; 1 (03) e180453
    CrossrefPubMedGoogle Scholar
  • 7 Haire WD. Vena caval filters for the prevention of pulmonary embolism. N Engl J Med 1998; 338 (07) 463-464
    CrossrefPubMedGoogle Scholar
  • 8 Gillespie DL, Spies JB, Siami FS, Rectenwald JE, White RA, Johnson MS. Predicting the safety and effectiveness of inferior vena cava filters study: design of a unique safety and effectiveness study of inferior vena cava filters in clinical practice. J Vasc Surg Venous Lymphat Disord 2020; 8 (02) 187-194.e1
    CrossrefPubMedGoogle Scholar
  • 9 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338 (07) 409-415
    CrossrefPubMedGoogle Scholar
  • 10 Soeiro AdeM, Fernandes FL, Teixeira RP. et al. Intracardiac embolization of inferior vena cava filter associated with right atrium perforation and cardiac tamponade. Rev Bras Cir Cardiovasc 2014; 29 (02) 285-288
    PubMedGoogle Scholar
  • 11 Owens CA, Bui JT, Knuttinen MG. et al. Intracardiac migration of inferior vena cava filters: review of published data. Chest 2009; 136 (03) 877-887
    CrossrefPubMedGoogle Scholar
  • 12 Nicholson W, Nicholson WJ, Tolerico P. et al. Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Arch Intern Med 2010; 170 (20) 1827-1831
    CrossrefPubMedGoogle Scholar
  • 13 Weinberg I, Kaufman J, Jaff MR. Inferior vena cava filters. JACC Cardiovasc Interv 2013; 6 (06) 539-547
    CrossrefPubMedGoogle Scholar
  • 14 Senitko M, Sims R, Dolmatch B, Vazquez MA, Lu CY. Inferior vena cava (IVC) filter thrombosis in a renal transplant recipient. Clin Nephrol 2009; 71 (04) 456-459
    CrossrefPubMedGoogle Scholar
  • 15 Ollila T, Naeem S, Poppas A, McKendall G, Ehsan A. Embolization of inferior vena cava filter Tyne and right ventricular perforation: a cardiac missile. Ann Thorac Surg 2016; 102 (06) e515-e516
    CrossrefPubMedGoogle Scholar
  • 16 Chandra PA, Nwokolo C, Chuprun D, Chandra AB. Cardiac tamponade caused by fracture and migration of inferior vena cava filter. South Med J 2008; 101 (11) 1163-1164
    CrossrefPubMedGoogle Scholar
  • 17 Stein PD, Kayali F, Olson RE. Twenty-one-year trends in the use of inferior vena cava filters. Arch Intern Med 2004; 164 (14) 1541-1545
    CrossrefPubMedGoogle Scholar
  • 18 Jackson BS, Sepula M, Marx JT, Cannon CM. Inferior vena cava filter limb fracture with embolization to the right ventricle. J Emerg Med 2017; 53 (02) 248-251
    CrossrefPubMedGoogle Scholar
  • 19 Removing Retrievable Inferior Vena Cava Filters. FDA Safety Communication. Poster online May 6, 2014. Accessed April 25, 2021 https://wayback.archive-it.org/7993/20170111070016/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm
    Google Scholar
  • 20 Kuo WT, Robertson SW. Bard Denali inferior vena cava filter fracture and embolization resulting in cardiac tamponade: a device failure analysis. J Vasc Interv Radiol 2015; 26 (01) 111-5.e1
    CrossrefPubMedGoogle Scholar
  • 21 Rogers NA, Nguyen L, Minniefield NE, Jessen ME, de Lemos JA. Fracture and embolization of an inferior vena cava filter strut leading to cardiac tamponade. Circulation 2009; 119 (18) 2535-2536
    CrossrefPubMedGoogle Scholar
  • 22 Kuyumcu G, Walker TG. Inferior vena cava filter retrievals, standard and novel techniques. Cardiovasc Diagn Ther 2016; 6 (06) 642-650
    CrossrefPubMedGoogle Scholar
  • 23 Sella DM, Oldenburg WA. Complications of inferior vena cava filters. Semin Vasc Surg 2013; 26 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 24 Saeed I, Garcia M, McNicholas K. Right ventricular migration of a recovery IVC filter's fractured wire with subsequent pericardial tamponade. Cardiovasc Intervent Radiol 2006; 29 (04) 685-686
    CrossrefPubMedGoogle Scholar
  • 25 Lahey SJ, Meyer LP, Karchmer AW. et al. Misplaced caval filter and subsequent pericardial tamponade. Ann Thorac Surg 1991; 51 (02) 299-300 , discussion 301
    CrossrefPubMedGoogle Scholar