A 62-year-old woman presented with a chief complaint of unhealed ulcers of the left lower extremity for >6 months. She was hospitalized in a local hospital in 2008 due to left iliofemoral deep vein thrombosis with extension into the inferior vena cava (IVC). She subsequently developed pulmonary embolism despite being anticoagulated. The patient underwent a TRAPEASE IVC placement filter (Cordis, Miami Lakes, FL) and started on oral anticoagulant medication using warfarin. She has not been followed up for 16 years postoperatively. Physical examination and laboratory results were unremarkable during this hospitalization in 2024. Duplex ultrasound examination revealed chronic left lower extremity thrombi. Contrast-enhanced computed tomography during this hospitalization revealed that the filter had perforated the IVC with all six legs (A/Cover-C) Luckily, no surrounding structures were injured. The patient refuses to undergo filter removal surgery. She had regular follow-up visits during which no abdominal symptoms have been reported and no complications have developed. In addition, the patient's ulcer healed under appropriate wound care 1 month later.
Although anticoagulation is currently the optimal management for deep vein thrombosis and pulmonary embolism, IVC filter placement is necessary in those with contraindications to anticoagulation. Generally speaking, IVC filter placement is a low-risk endovascular procedure with low complication rates, which include filter tilting, migration, fracture, struts perforation, and filter thrombosis. Most strut perforations are discovered incidentally without symptoms, but have the potential for clinically significant sequelae in the event of penetration into nearby organs and vasculature. Perforation of the surrounding structures such as duodenum, ureters, and aorta has been reported.1, 2, 3 Because the risk of developing complications is low in asymptomatic patients with no perforation of the surrounding structures, these patients are usually managed conservatively. Patient consent has been obtained.
Funding
None.
Disclosures
None.
Footnotes
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
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