2000 Volume 11 Issue 3 Pages 265-270
The temporary inferior vena cava (IVC) filter is effective for protection against pulmonary embolism (PE) associated with acute proximal deep vein thrombosis in patients contraindicated for anticoagulant therapy or who have undergone thrombolytic therapy or thrombectomy. We report a rare filter complication in man who suffered from IVC thrombosis due to renal transitional cell carcinoma. A 47-year-old man was admitted to our hospital with an abdominal mass and edema of both lower extremities. CT and MRI imaging revealed a tumor in the left kidney with extension into the renal vein and IVC, resulting in secondary thrombi in the infrarenal IVC. A radical nephrectomy was planned. Two days before surgery, a temporary IVC filter was implanted via the right internal jugular vein into the suprarenal IVC for protection against massive PE during surgery. That night, the patient felt a dull pain in the upper abdomen and coughed vigorously for about 30 minutes. Abdominal X-ray revealed no migration of the filter: however, a deformity of one of the six limbs was observed, which due to accidental insertion of the limb into the right hepatic vein. When the filter was retrieved carefully under fluoroscopic observation after surgery, one of the limbs was found to be detached from the filter and migrated into the left pulmonary artery. It was recovered immediately by successful catheter manipulation and without complication. It appeared that the deformed limb had been continuously stressed by the upward and downward movement of the filter upon respiration and finally separated form its attachments. Breakage of the temporary IVC filter is a rare complication, but we should be aware of such possibility when implanting into the suprarenal IVC.
