Retrievable Guenther Tulip Filter Complicated by Sepsis and Retroperitoneal Hemorrhage: Successful Management by Filter Retrieval

Abstract

We encountered complications of septic shock and retroperitoneal hemorrhage which occurred after implantation of a retrievable Günther Tulip filter. A 79-year-old woman was diagnosed as right femoral vein thrombosis, and a retrievable Günther Tulip filter was deployed prior to a total knee replacement surgery. However, the patient developed septicemia due to Citrobacter freundii, followed by thrombocytopenia and retroperitoneal hemorrhage. A large hematoma was formed along the lateral side of the filter struts. We considered that the filter should be removed to control retroperitoneal hemorrhage and prevent secondary infection of the hematoma. Removal of the retrievable filter was effective in managing these complications.

CT of inferior vena cava filters: normal presentations and potential complications

“…If infection is thought to be related to the filter, removal should be attempted if feasible. IVC filter removal was reported in a case of a retroperitoneal hemorrhage secondary to a perforating IVC filter strut which occurred during filter placement [40]. The patient then developed septicemia due to Citrobacter freundii while hospitalized.…”

“…The patient then developed septicemia due to Citrobacter freundii while hospitalized. The patient's retrievable Günther Tulip filter was removed to prevent further bleeding into the hematoma and to prevent or reduce secondary infection of the retroperitoneal hematoma [40]. In another case, a report of Candida thrombophlebitis secondary to IVC filter infection, a Günther Tulip filter was removed 15 days after insertion, and the patient was successfully treated with IV antifungal therapy [41].…”

Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology

“…A "fresh stick" access site is recommended (ie, jugular or femoral vein), away from any indwelling catheters that may harbor bacteria and become dislodged by the filter device (119). In the rare instance in which a patient with septic at risk for life-threatening pulmonary embolism requires an IVC filter, the use of a retrievable filter is advisable, as it can be removed if the infection cannot be cleared (120). (No new data or changes to recommendations.…”

Interrupción de la vena cava inferior mediante filtros de inserción percutánea: Indicaciones y resultados en 287 pacientes

“…Las complicaciones derivadas del filtro, si bien están comunicadas en la literatura, son extremadamente poco frecuentes. Han sido descritos casos de falla del material 17,18 , migración del filtro dentro del aparato circulatorio o su fistulización a órganos vecinos requiriendo ocasionalmente tratamiento quirúrgico o endovascular para su resolución [3][4][5][19][20][21][22][23][24][25][26] ; la infección del filtro es un evento excepcional 27 . Es necesario considerar estas complicaciones en pacientes que posean un filtro en la vena cava y que se presenten con sintomatología poco habitual.…”