IVC Filter Perforation: A Rare Cause of Abdominal Pain

Abstract

Abdominal pain is one of the most common complaints of patients seeking medical care. Devices such as inferior vena cava (IVC) filters are frequently placed in patients with deep vein thrombosis and contraindications to anticoagulation. Symptomatic perforation of the filter into the adjacent tissue or vessels is a rare, but challenging, complication. A 65-year-old woman with a history of asthma and anxiety presented to clinic with abdominal pain. Seven weeks prior, she had been hospitalized for a diverticular bleed and focal diverticulitis. During her stay, venous sonography demonstrated a right femoral vein thrombosis and anticoagulation was initiated with heparin. She developed significant rectal bleeding leading to anticoagulation discontinuation and placement of a retrievable IVC filter. On presentation to the clinic, she reported lower back pain radiating to the right flank and buttock, nausea, and cramping post prandial abdominal pain. She had previously presented to a local emergency department with these symptoms and was prescribed an anti-spasmodic agent after clinical and laboratory evaluation was unrevealing. Now, seven weeks later, she reported persistence of symptoms. On evaluation, she was afebrile, hemodynamically stable, and physical examination was without abnormalities. CT scan of the abdomen and pelvis revealed caudal migration of the IVC filter with the primary legs perforating the IVC and splaying into the L3/L4 intervertebral disc space and aorta (Figures 1,2). She was admitted for endovascular retrieval of the IVC filter. A post-retrieval vena cavagram and CT angiogram with 3D vessel reconstruction demonstrated no complications such as peri-caval hematoma. Her symptoms resolved and she was discharged home the following day. Perforation of the IVC by a primary leg of the device is a rare, but important complication. Symptomatic perforation usually presents in the days to weeks following placement; however, symptoms may not manifest for years later. It is wise to have a high index of suspicion in patients with recent filter placement with only vague abdominal complaints that cannot be otherwise explained. Retrievable filters should be removed as soon as they are no longer needed. We recommend prompt removal of the device via endovascular or surgical approach for symptomatic perforations and asymptomatic perforations involving vital tissues such as the aorta, small bowel, and bone.Figure 1Figure 2