Endovascular retrieval of Greenfield IVC filters 13 and 19 years post placement without major complication

摘要

Inferior vena cava (IVC) filters were first introduced in 1967 by Kazi Mobin-Uddin and later improved by Lazar Greenfield in the 1980s becoming a major component of catastrophic pulmonary embolism prevention. Nevertheless, filters are not entirely harmless. The long term risks include caval thrombosis, visceral penetration, and filters can serve as a nidus for infection. Filter retrieval is often complicated by intimal hyperplasia especially with increased indwelling time. Historically, Greenfield filters in place for longer than 3 weeks were considered permanent due to the risks of retrieval. Herein we present 2 cases of successful retrieval of Greenfield filters 13 and 19 years post implantation. Keywords. IVC, Filter, Loop-snare, Endovascular, VenousCASE REPORTCASE 1A 32-year-old male presents to interventional radiology clinic with a history of a significant motor vehicle accident in 2002 where he sustained multiple pelvic fractures. Given his high risk for DVT and contraindication to anticoagulation, a Greenfield (Boston Scientific, Marlborough, MA) IVC filter was placed in May 2002. The patient was asymptomatic but routine laboratory testing at an outside hospital demonstrated iron deficiency anemia. The patient had an upper endoscopy (Figure 1a–d) performed on March 2015 to evaluate his anemia. Two sharp linear metallic objects were noted within the lumen of the second portion of the duodenum. The endoscopist briefly tried to explant one of the objects but there was significant resistance and only a small portion of it was removed. A noncontrast CT scan of the abdomen (Figure 2a–c) was then performed which demonstrated an infrarenal Greenfield IVC filter with visceral penetration into the transverse duodenum as well as penetration into the right psoas muscle. Open in a separate windowFigure 1 32 year old male with anemia secondary to strut penetration into the duodenum.Findings.a) A sharp metallic object (Green arrow) is seen projecting into the lumen of the duodenum with blood oozing around the entry site.b) A close-up evaluation of the object.c) Endoscopic forceps were utilized to the objectd) Site of ulceration at the site of penetration (Yellow arrow).Technique. Upper GI endoscopy.