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Patent foramen ovale closure in a patient with vena cava filter: a case report
Pierluigi Omedè1, Pier Paolo Bocchino1, Ovidio De Filippo1
1Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Corso Bramante 88/90, 10126 Turin, Italy.
Insights
Patent foramen ovale (PFO) closure can prevent strokes, but inferior vena cava filters (IVCFs) may complicate the procedure. This case shows successful PFO closure with an IVCF in place, demonstrating feasibility for future interventions.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Patent foramen ovale (PFO) is linked to cryptogenic strokes and PFO closure reduces recurrence risk.
- Inferior vena cava filters (IVCFs) are used to prevent pulmonary embolism but can impede transfemoral procedures.
- Transfemoral Patent foramen ovale closure is a common procedure for stroke prevention.
Observation:
- A 50-year-old male with PFO experienced an ischemic stroke due to paradoxical embolism.
- The patient required an IVCF, and subsequent attempts to retrieve it failed.
- A transfemoral PFO closure was successfully performed with the IVCF in situ.
Findings:
- The delivery system successfully traversed the IVCF, enabling PFO closure.
- The patient was discharged in good condition with no reported stroke recurrence at 5-month follow-up.
- This case demonstrates the feasibility of performing PFO closure in the presence of an IVCF.
Implications:
- Crossing an IVCF with catheters and delivery systems is possible, opening new interventional avenues.
- This technique may be crucial for patients requiring both IVCF and PFO closure.
- Further research into IVCF crossing techniques can expand interventional treatment options.
Background:
The presence of a patent foramen ovale (PFO) is associated with several medical conditions, including cryptogenic left circulation thromboembolism. PFO closure was demonstrated to reduce recurrent ischaemic stroke in patients with prior cryptogenic stroke. The presence of an inferior vena cava filter (IVCF), however, may impede a transfemoral PFO closure procedure.
Case Summary:
We describe the case of a 50-year-old man with a PFO suffering from ischaemic stroke from paradoxical thromboembolism originating from deep vein thrombosis and requiring an IVCF. After deep vein thrombosis resolution, due to the high risk of stroke recurrences, the patient was recommended PFO closure. IVCF retrieval by the interventional radiologist was first attempted but failed. A transfemoral PFO closure procedure was thus endeavoured with the IVCF in place and was successful. The patient was then discharged in good clinical status and no stroke recurrences were reported at 5 months follow-up.
Discussion:
Albeit an IVCF provides benefit in patients with recurrent thromboembolic events despite adequate anticoagulation therapy, its presence may hinder interventional procedures necessitating delivery systems to advance through the inferior vena cava. We reported on a successful PFO closure procedure via a femoral venous access in a patient with an IVCF in place, thus demonstrating the feasibility of advancing delivery systems through an IVCF. As interventional procedures requiring the advancement of delivery systems through the inferior vena cava are becoming increasingly common, the feasibility of IVCF crossing with catheters and delivery systems alike paves the way for novel interventional possibilities.
