Endovascular retrieval of a Gunther-tulip vena cava filter migrated into the right atrium

A 72-year-old male underwent placement of a Gunther-tulip vena cava filter to prevent development of a pulmonary embolism. One month later, when we tried to retrieve the Gunther-tulip vena cava filter via a transjugular approach, the filter detached from the snare and became free in the outer sheath. The Gunther-tulip vena cava filter did not reopen in the inferior vena cava probably because it became entangled with a thrombus; rather, the filter migrated into the right atrium. The filter orientation rendered the transjugular approach inappropriate; we used a bilateral transfemoral approach to aid filter retrieval. It is necessary to be very cautious when reopening a filter that has closed within the sheath. Although the filter migrated into the heart, we retrieved it using a combined approach.