INTRA-CARDIAC EMBOLIZATION OF AN INFERIOR VENA CAVA FILTER RESULTING IN CARDIAC ARREST

Abstract

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Inferior vena cava (IVC) filters are commonly used to prevent pulmonary emboli (PE) in patients with high thromboembolic risk and an absolute contraindication to anticoagulation. These devices can offer life-saving protection but are not without risk. The overall complication rate associated with IVC filters is low, but several known device-related complications are associated with significant morbidity and mortality, including in-situ IVC thrombus, filter perforation, filter fracture, and/or filter embolization. Rates of filter embolization are exceptionally low, with an incidence of less than 1 percent, and most often occur at the time of device deployment. Here, we present a case of delayed, intra-cardiac IVC filter embolization leading to cardiac arrest. CASE PRESENTATION: A 49-year-old man with a past medical history significant for recurrent thromboembolic disease with known acute right lower extremity deep vein thrombosis and chronic superior mesenteric vein thrombus was admitted to the intensive care unit for a massive upper gastrointestinal bleed secondary to duodenal varices identified on esophagogastroduodenoscopy (EGD). His duodenal varices were not amenable to endoscopic intervention. Given his elevated risk for recurrent gastrointestinal bleeding and recurrent thromboembolic disease, an IVC filter was placed without complication. Two days later, following a repeat EGD for attempted histoacryl variceal gluing, the patient experienced sudden cardiac arrest, characterized by pulseless monomorphic ventricular tachycardia. He was resuscitated for approximately 70 minutes with intermittent return of spontaneous circulation and ability to follow commands. Bedside cardiac ultrasound during the resuscitation revealed a multi-lobulated, mobile mass intertwined within the tricuspid valve. After stabilization, computed tomography of the chest with angiography showed a saddle pulmonary embolism with migration of the IVC filter into the right ventricle. He underwent emergent sternotomy with thromboembolectomy and retrieval of the embolized IVC filter. He made a complete recovery after surgery and was discharged to independent living from the hospital with a new IVC filter in place. DISCUSSION: IVC filter embolization is a rare but potentially fatal complication, and sudden cardiac arrest is a common presentation. Bedside ultrasound is useful for early diagnosis. As evidenced by the patient presented here, prompt identification and removal of the embolized filter can lead to positive patient outcomes. CONCLUSIONS: Intra-cardiac embolization of IVC filters can occur days after device deployment and lead to life-threatening cardiac arrhythmias. Reference #1: Grewal S, Chamarthy MR, Kalva SP. Complications of inferior vena cava filters. Cardiovascular Diagnosis and Therapy. 2016;6(6):632-641. Reference #2: Athanasoulis CA, Kaufman JA, Halpern EF, et al. Inferior vena caval filters: review of 26-year single-center clinical experience. Radiology. 2000;216(1):54-66. Reference #3: Owens CA, Bui JT, Knuttinen MG, et. Al. Intracardiac migration of inferior vena cava filters: review of published data. Chest. 2009;136(3):877-887. DISCLOSURES: No relevant relationships by Max Martin, source=Web Response No relevant relationships by Kelly Pennington, source=Web Response No relevant relationships by Michael Wilson, source=Web Response