C63-28 When “Caps Off” Is Not the End: Migrated IVC Filter Cap to the Heart

Abstract Introduction Inferior vena cava filters serve as mechanical prophylaxis when anticoagulation therapy is contraindicated. Although retrievable filters were designed for temporary use, real-world retrieval rates remain lower than expected. Intracardiac migration of filter components represents an exceedingly rare complication, occurring in less than 1% of cases, yet poses significant clinical dilemmas regarding management strategies. The decision between conservative observation and interventional removal requires careful risk-benefit analysis considering fragment characteristics, patient symptoms, and procedural risks. We present a unique case of IVC filter cap migration to the right ventricle during attempted retrieval of the filter. Description A male patient who initially presented with a provoked bilateral pulmonary embolism due to immobilization after trauma, which resulted in severe cervical spinal canal stenosis with cord compression at C5-C6 (resulting in incomplete tetraplegia). This was further complicated by the presence of left lower extremity deep vein thrombosis (DVT), which required anticoagulant therapy. Surgery was eventually planned, and infrarenal Convertible Venatech IVC filter placement was performed given his persistent risk factors and high risk for pulmonary embolism post-surgery. Following cervical decompressive surgery 1 year after the event, he demonstrated remarkable recovery, progressing from immobility to ambulation using a walker. However, during attempted IVC filter removal, the filter cap migrated into the right ventricle and became embedded in the myocardium. Given the peripheral myocardial location and associated procedural risks, interventional radiology recommended conservative management over invasive retrieval. Serial imaging, including CT angiography, was performed at 1 year (Figure 1. C and D) confirmed the persistent retention of the metallic cap. At the recent evaluation, at least 3 years after the cap migration, the patient remained clinically stable. Serial chest radiographs from 3 years consistently showed clear lungs, with persistence of the filter cap. The patient continues annual surveillance, demonstrating functional neurological recovery while maintaining cardiopulmonary stability and being asymptomatic despite the retained intracardiac foreign body. Discussion Migration of IVC filter pieces is a relatively rare complication related to IVC filters. Furthermore, migration into the heart is rare. Our case demonstrates a successful conservative approach to managing this complication. This highlights the importance of individualized risk-benefit analysis when managing intracardiac foreign bodies, considering factors such as fragment characteristics, anatomical location, and patient-specific risks. Successful long-term conservative management in this case provides valuable evidence to guide clinical decision-making in similar uncommon but challenging scenarios. This abstract is funded by: None