Inferior vena cava filter misplacement in the right ovarian vein and successful removal by loop-snare technique in a patient with inferior vena cava agenesis

Abstract

Misplacement of an inferior vena cava (IVC) filter in a gonadal vein is a rare complication of IVC filter placement. We report a case of a filter misplaced in the ovarian vein of a pregnant woman with agenesis of the infrarenal IVC and bilateral lower extremity deep venous thrombosis. The filter was removed by a loop-snare technique through an internal jugular vein. IVC agenesis and dilated right gonadal vein should be kept in mind when an IVC filter is being inserted in the infrarenal location through the jugular approach.

The wire loop technique for IVC filter removal

“…The wire loop technique is an advanced endovascular retrieval method for IVC filters complicated by tilting and migration [9][10][11][12] . This case report and video illustrate details and tips for a successful wire loop technique in challenging IVC filter retrieval characterized by strut penetration, extensive fibrosis, prolonged indwelling time of 4 years and a severe tilt with the hook abutting the wall of the cava.…”

Not so fast with the filter! Is it really in the inferior vena cava?

“…[4] ere have been four recognized cases of the IVC filter malposition in the right gonadal vein. [5][6][7][8] One of those cases involved a significantly dilated right ovarian vein that was confused for the IVC because of infrarenal IVC agenesis. [5] On the post-procedure scan, the dilated right ovarian vein was distinguished from the IVC by finding the ovarian vein communicating with the pelvic varicosities and the IVC communicating with the bilateral common iliac veins.…”

“…[5][6][7][8] One of those cases involved a significantly dilated right ovarian vein that was confused for the IVC because of infrarenal IVC agenesis. [5] On the post-procedure scan, the dilated right ovarian vein was distinguished from the IVC by finding the ovarian vein communicating with the pelvic varicosities and the IVC communicating with the bilateral common iliac veins. Other factors that may lead to malpositioning include suboptimal access route and intraprocedural technique.…”

Inadvertent noncaval filter deployment and its management

“…Although rarely described in the literature, operator error is a potential area of complication to bring to light. There have been case reports of filter placements in gonadal vein, ovarian vein, and right atrium 5, 6, 7. Another case reported incorrect orientation of the filter 8 .…”

“…These errors possibly left the filter nonfunctional and cause a challenging retrieval case. Nonstandard endovascular techniques to retrieve these IVC filters were described 7 . These techniques include but are not limited to filter buddy wire, aggressive traction, laser sheath, and loop-snare technique.…”