Make the Diagnosis: Should it stay or should it go?

Presentation

Case Findings: An adult presents with an inferior vena caval (IVC) filter that was removed.

What is your diagnosis?

Learnings

This patient had a preexisting deep vein thrombosis. Inferior vena caval (IVC) filters can help prevent pulmonary embolism in cases of preexisting DVT. IVC filters may be temporary or permanent. They are inserted via a jugular or femoral vein, and ultrasound or fluoroscopy are often used for guidance. Most filters are permanent, but younger patients with few risk factors may receive a retrievable filter.

When Filters are Used:

Common indications for using IVC filters include cases where a thrombus has formed despite anticoagulation treatment, or cases in which anticoagulation is contraindicated. In general, older patients at greater risk receive permanent filters. However, any IVC filters may need to be removed if complications occur.

Possible Complications:

Complications associated with IVC filters may be procedure-related or delayed. Procedure-related complications are generally minor, and include infection, hematoma, bleeding at the access site, accidental arterial puncture, and poor positioning of the filter, according to a 2006 review. Delayed complications include perforation of the IVC wall by the filter struts, filter fracture, filter migration, DVT, and pulmonary embolism.

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Make the Diagnosis: Should it stay or should it go?