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

Abstract

Background: 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. Case report: 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. Conclusions: 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.