Renal artery inferior vena cava arteriovenous fistula complicated by renal infarction after difficult inferior vena cava filter retrieval: A case report

Inferior vena cava (IVC) filters are used to reduce the risk of pulmonary embolism when anticoagulation is contraindicated; however, retrieval of embedded filters may require advanced techniques with minor risks of rare vascular complications. We report the case of a 75-year-old man who underwent infrarenal Denali IVC filter placement for acute lower-limb deep vein thrombosis after anticoagulation was discontinued due to spontaneous intramuscular hemorrhage. Four months later, filter retrieval was attempted. Standard snare and loop-and-snare techniques were unsuccessful, necessitating retrieval using endobronchial forceps. Completion cavography showed preserved IVC patency with a suspected contained perforation but no evidence of immediate arteriovenous shunting. Five days later, computed tomography angiography (CTA), performed to investigate an unexplained hemoglobin level drop, revealed complete right renal infarction and a short, wide arteriovenous fistula between the right renal artery and the IVC. The kidney was deemed nonsalvageable, and the fistula was not amenable to endovascular embolization. Follow-up imaging confirmed complete right renal atrophy. This case highlights a rare delayed renal arteriocaval complication following forceps-assisted IVC filter retrieval. It emphasizes the importance of early computed tomography angiography in patients with unexplained anemia or renal perfusion abnormalities after complex filter retrieval.