Successful Endovascular Removal of a Perforated Inferior Vena Cava Filter Complicated by a Large Retroperitoneal Hematoma: Pitfall of Catheter-Directed Thrombolysis

Abstract

Symptomatic caval perforation is rare complication after inferior vena cava (IVC) filter insertion. A 44-year-old woman developed back pain after the placement of retrieval IVC filter during catheter-directed thrombolysis (CDT). Her computed tomography showed a large right-sided retroperitoneal hematoma. After 2 weeks, endovascular removal of the perforated filter was successfully performed without complication. Because thrombolytic agents can accelerate bleeding caused by endovascular procedures, the bleeding rate of the IVC filter deployment during CDT might be higher than expected.

Complications of inferior vena cava filters

“…Reports of perforation into the duodenum, the aorta (Figure 9), and renal pelvis have been reported (42)(43)(44). Concomitant anticoagulation in the setting of IVC filter perforation increases the risk of bleeding and may lead to retroperitoneal hematoma formation (45). A high clinical suspicion for perforation should be maintained with non-specific abdominal or back pain in patients with an IVC filter.…”