Complex inferior vena cava filter retrieval in a patient presenting with ureteral obstruction

Abstract

PurposeTo present a case of a complex inferior vena cava (IVC) filter complication in a patient with a congenital urinary tract anomaly. Case descriptionA 69-year-old Caucasian female with a retrievable IVC filter placed prophylactically before a hysterectomy 13 years prior presented with right flank pain and abdominal fullness. Computed tomography with intravenous pyelogram revealed right hydronephrosis, which appeared to cause the pain. The IVC filter was noted to be malpositioned distal to the area of the hydronephrosis and perforating through the IVC in several places resulting in periureteral fibrosis causing an obstruction. She was also noted anomalous anterior courses of her proximal bilateral ureters, likely congenital in origin. The patient had two prior endovascular filter retrieval attempts, which were unsuccessful, and was ultimately referred to the urology team at the University of Colorado hospital for specialty care given her complex presentation. The decision was made to proceed with open pyeloplasty with explant of the malpositioned IVC filter followed by caval reconstruction in a joint case between the urology and vascular surgery teams. ConclusionOpen IVC filter retrieval with vena cava reconstruction is a plausible and highly efficacious option in patients presenting with ureteral compression and hydronephrosis secondary to a perforating IVC filter. A multidisciplinary team consisting of vascular and urological surgeons can address the complex involvement of adjacent organs concurrently and effectively.