080 - IVC Filter Removal Complicated by Duodenal Perforation: A Rare Case Report
Asad Baig, MD – Fellow/Attending, Interventional Radiology, Emory University/ Columbia University
Purpose: The patient was a pleasant 67-year-old female who presented to the hospital with recent onset severe abdominal pain and complaints of swelling in her lower extremities. Imaging demonstrated Filter penetration anteriorly into the horizontal segment of the duodenum. On further imaging, it was noted the IVC was severely stenotic, resulting in lower extremity symptoms. It was planned to do IVC filter removal with Ileocaval stenting.
Material and Methods: 1. US-guided right IJ venous access, ultrasound-guided bilateral greater saphenous vein access 2. Inferior vena cavogram pre-filter removal 3. Fluoroscopic-guided IVC filter removal 4. Inferior vena cavogram post-filter removal 5. Iliocaval venous stent placement and venoplasty utilizing fluoroscopy as well as IVUS. 6. Post stenting venogram
After careful measurements with IVUS and venograms marking the renal veins as well as other anatomic landmarks, 2 stents were deployed simultaneously within the IVC, and bilateral stents were placed in the common iliac veins. Balloon venoplasty was performed. Venograms were performed to demonstrate brisk flow through the stents.
A 0.018" wire an 0.035" wire 22 French dry seal sheath 16 French sheath 0.035 wire Gooseneck Snare Stents used were Abre 16 x 120 (x 2) IVC Abre, 14 x 120 Right iliocaval, Abre 14 x 100 Left iliocaval and Venoplasty with 16 and 14 balloon respectively
Results: Successful IVC filter removal with Ileocaval stenting bilaterally.
Conclusions: IVC filter is an excellent option for patients with a risk of developing pulmonary emboli however, they do come with risks. There should be a high suspicion of IVC filter perforation in patients who have a history of IVC filter placement and present with acute onset epigastric pain. A thorough history and appropriate diagnostic imaging are crucial to reaching the diagnosis followed by early intervention to prevent further complications.