Fig. 7
From: Procedural complications of inferior vena cava filter retrieval, an illustrated review
This patient had a Günther Tulip IVC filter (Cook, Bloomington, IN) for PE prophylaxis after a motor vehicle accident and was lost to follow-up until imaging was done for unrelated reasons 10.5 years later. Pre-retrieval CT (a + b) showed penetration of 2 legs of the filter into the doudenum. Given embedded legs, a a 14Fr Excimer laser sheath was employed (c). The day after retrieval, the patient developed fevers and 8 days later he underwent CT of the chest, abdomen and pelvis. Chest CT showed multiple cavitary nodules, pulmonary emboli (not shown) and new IVC clot with a small focus of gas at the cranial aspect of the clot (d + e). After filter placement cranial to this clot (f) and subsequent clot aspiration 20 French FlowTriever® Aspiration device (Inari Medical, Irvine, CA), cavagram showed a fistula to the doudenum (g). After the patient was placed on antibiotics and anticoagulation, bacteremia and IVC clot resolved. A case of a doudenal-caval fistula caused by an in-situ IVC filter has been reported in the literature (Vandy et al. 2011). Doudenal-caval fistula or septic VTE have not yet been described after filter removal, however