Fig. 2

This patient had undergone placement of a Cook Celect filter (Cook, Bloomington, IN) 24 weeks prior to presentation for filter retrieval. Pre-procedure CT showed the right hook of the IVC filter to be protruding into the right renal artery. Cavagram showed an angulated filter with an embedded hook and therefore bronchial forceps were used. After technically sucessful filter retrieval, the patient developed hypotension and right sided flank pain. CT showed a right sided retroperitoneal hemorrhage and an infarcted right kidney. Angiogram was done demonstrating a fistula between the right renal artery and IVC and the renal artery was embolized with a 12 mm Amplatzer Vascular plug. In this case, with pre-procedure CT evidence of the hook penetrating into the renal artery, obtaining arterial access could have been done to allow imaging and potential treatment of any renal arterial disruption during retrieval