A case of transcatheter removal of a briefly penetrated inferior vena cava filter in an open abdomen

Abstract

Abstract Background The likelihood of inferior vena cava filter penetration increases with prolonged implantation. Despite the generally low risk associated with an ALN inferior vena cava filter (ALN IMPLANTS CHIRURGICAUX, Ghisonaccia, France), we present a case in which penetration occurred 43 days after implantation. There is currently no consensus on the standardized approach for filter removal in cases. In this report, we describe a secure and reliable method involving surgical access to the abdomen and transcatheter filter removal while directly observing the inferior vena cava. Case Presentation A 72-year-old Japanese male patient presented to our institution with complaints of pain and subsequent edema in his left lower limb. Contrast-enhanced computed tomography (CT) revealed thrombi spanning from the left common iliac vein to the external iliac vein, as well as in the right pulmonary artery and inferior vena cava. Upon admission, we promptly inserted an ALN inferior vena cava filter and initiated anticoagulation therapy. Follow-up contrast-enhanced CT performed on day 13 after filter implantation demonstrated the disappearance of thrombi in the pulmonary artery and inferior vena cava, and the patient was discharged on day 14 following implantation. However, due to the presence of a residual thrombus in the left common iliac vein, we decided against removing the inferior vena cava filter at that time. Contrast-enhanced CT performed on day 43 after implantation revealed signs suggestive of filter penetration with extension into the abdominal aorta, necessitating immediate filter removal. To address this, we performed transcatheter removal of the filter through open abdominal surgery. Conclusions An ALN inferior vena cava filter, initially considered to pose a low risk of penetration, unexpectedly exhibited penetration during the brief indwelling period. Although a definitive consensus concerning the optimal removal approach for such cases remains elusive, our experience indicates that transcatheter removal via laparotomy represents a secure and reliable method.