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Background
There is currently a great deal of publicity around complications of Inferior Vena Caval filters. This results in the vascular surgeon having to counsel many patients on complications of filters and providing reassurance to others. However, there is increasing recognition of filters as a cause of complications and as a source of symptoms. Vascular surgeons must be aware of both endovascular and open options for these patients.
Case Report
A 34 year old male presented with the complaint of swelling of his right leg and a history of DVT. A Trapease IVC filter had been placed in an outside institution. This filter was mal-deployed in the lower IVC and proximal right common iliac vein. The patient also complained of lower abdominal and back pain.
A CT scan demonstrated that the right common iliac vein, including the lower half of the filter was occluded. An ascending venogram showed that the right leg drained across the pelvis to the left iliac system and up through the common iliac vein to the IVC. Of particular concern was that the filter legs protruded into the termination of the left common iliac vein, where it was significantly compressed by the iliac artery. An attempt was made to cross the occlusion from below with a guide wire but this was unsuccessful.
We opted to proceed with open removal. This technique is demonstrated in the accompanying video. Basically, the distal IVC and common iliac vein was opened, the filter removed with some difficulty due to chronicity. Inflow from the right iliac system was surprisingly achieved and the entire venotomy patched with a Bovine pericardial patch.
The patient tolerated the procedure well with improvement of both the leg swelling and the abdominal and back pain.
Summary
Open removal of a Trapeze IVC filter, presents some technical challenges, which we have illustrated. Awareness of these challenges is important for vascular surgeons who are increasingly presented with IVC filter complications.