Abstract Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients with contraindications to anticoagulation or recurrent thromboembolic events. Although generally safe, prolonged indwelling filters carry a risk of delayed complications, including fracture, migration, caval perforation, and embolization to visceral or cardiac structures. These events may occur years after placement and present with variable clinical symptoms. We report a case of a young male who developed cardiac and hepatic embolization of an IVC filter requiring surgical retrieval from the right ventricle. A young man with a history of a motor vehicle accident in 2005, resulting in multiple fractures and deep vein thrombosis treated with IVC filter placement, presented with several months of intermittent right lower quadrant abdominal pain that acutely worsened after physical exertion. Initial workup revealed mild transaminitis and elevated lipase. CT abdomen and pelvis demonstrated an old infrarenal IVC filter with fractured struts extending beyond the vessel wall and metallic fragments lodged in the hepatic segment, right and left ventricle. Interventional Radiology (IR) attempted retrieval; however, fragments embedded in the heart and distal pulmonary vessels were not accessible. Cardiothoracic Surgery (CTS) was consulted, and the patient underwent open surgical removal of a fractured filter strut from the right ventricle. The fragment was entwined with the chordae of the posterior tricuspid leaflet and was excised without structural injury. Patient recovered well postoperatively, with resolution of presenting symptoms and normal ventricular function confirmed by echocardiography. Two months later, he re-presented to the hospital with left-sided chest pain radiating to the shoulder and back, associated with dyspnea. CT angiogram of the chest revealed no pulmonary embolism or intrathoracic foreign body. Still, it showed a small pericardial effusion and a residual metallic fragment in the right hepatic lobe with no distal migration from prior. Inflammatory markers were elevated, and he was treated for post-surgical pericarditis with anti-inflammatory therapy, resulting in clinical improvement. Fracture and embolization of IVC filters are recognized but underreported late complications, with a prevalence estimated between 10%-16% in long-term follow-up studies. Embolized fragments can migrate to the heart or lungs, causing arrhythmias, valvular injury, tamponade, or sudden death. Early retrieval is strongly recommended once the indication for filtration resolves. In this case, delayed filter fragmentation led to hepatic and cardiac embolization nearly 2 decades after placement, underscoring the importance of lifelong vigilance and follow-up imaging in patients with unretrieved filters. This abstract is funded by: None
Venugopalan et al. (Fri,) studied this question.