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Vena cava filter ensnarement and delayed migration: an unusual series of cases
A Dardik1, K A Campbell, C J Yeo
1Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287-4605, USA.
Insights
Delayed complications and guidewire ensnarement of vena cava filters can occur, even years after placement. Awareness and modified endovascular techniques are crucial for preventing these serious filter complications.
Area of Science:
- Medical Devices
- Interventional Radiology
- Vascular Surgery
Background:
- Vena cava filters are used to prevent pulmonary embolism.
- Complications associated with vena cava filters require careful monitoring and management.
Observation:
- Retrospective review of 5 patients with vena cava filter complications at a tertiary care center.
- Complications included filter migration, guidewire ensnarement, and delayed strut extrusion.
Findings:
- Four cases of filter ensnarement by guidewires were identified, occurring during placement and years later.
- One case of delayed filter strut extrusion into the duodenum was documented.
- Filter migration was also observed in conjunction with guidewire complications.
Implications:
- Delayed vena cava filter complications should be considered in unexplained patient symptoms, irrespective of placement history.
- Modified endovascular procedures are recommended to prevent guidewire ensnarement of vena cava filters.
Purpose:
To review delayed and guidewire-induced morbidity associated with vena cava filters.
Methods:
The records from the Johns Hopkins Hospital, a tertiary care referral center, of all patients who had vena cava filter complications from August 1993 through July 1996 were retrospectively reviewed.
Results:
Five patients had filter migration or ensnarement with a guidewire. One patient had delayed extrusion of a filter strut into the duodenum. Four patients had filters ensnared by guidewires, including one during initial filter placement and one several years after placement.
Conclusions:
Delayed complications of vena cava filters should be considered whenever unusual patient signs or symptoms cannot be easily explained, even in the absence of a history of filter placement. To prevent guidewire ensnarement of filters, simple techniques should modify endovascular procedures when vena cava filters are present.