ALN inferior vena cava filter upside down rotation with chest caval migration in an asymptomatic patient

Percutaneous placement of an inferior vena cava (IVC) filter is indicated in patients affected by pulmonary embolism or proximal deep venous thrombosis when anticoagulation therapy is contraindicated or there is evidence of thromboembolic recurrence during anticoagulation. Several complications have been reported using IVC filters. Migration is a rare but known and potentially lethal complication of IVC filter placement. In this patient, an ALN IVC filter (ALN Implants Chirurgicaux Ghisonaccia, France) proximal migration occurred from the inferior cava vein to a zone just below the right atrium; it was associated with a complete 180 degrees rotation, and we describe here the procedure employed to successfully remove this filter.