Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9211-9217
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9211
Successful management of infected right iliac pseudoaneurysm caused by penetration of migrated inferior vena cava filter: A case report
Cheng-Xin Weng, Shu-Min Wang, Tie-Hao Wang, Ji-Chun Zhao, Ding Yuan
Cheng-Xin Weng, Shu-Min Wang, Tie-Hao Wang, Ji-Chun Zhao, Ding Yuan, Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Weng CX, Wang TH, Zhao JC and Yuan D performed the surgery; Weng CX, Wang TH and Wang SM collected the information and followed the patient; Wang TH and Yuan D revised the paper; all authors read and approved the final manuscript.
Supported by the Sichuan Foundation of Science and Technology, No. 2020YFS0247.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Authors certify that there is no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Chun Zhao, MD, PhD, Doctor, Surgeon, Department of Vascular Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. zhaojichundoc@163.com
Received: May 14, 2021
Peer-review started: May 14, 2021
First decision: July 6, 2021
Revised: July 17, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 26, 2021
Abstract
BACKGROUND

Indwelling inferior vena cava (IVC) filters might cause various complications, including filter penetration, filter fracture, filter migration, and thrombosis of the IVC. Penetration and migration complications are common, while a caudal migrated double-basket filter with associated infected iliac pseudoaneurysm has seldom been reported.

CASE SUMMARY

We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 mo. The patient had a history of failed endovascular IVC filter retrieval. Computed tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein, leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis, and bilateral iliac veins were occluded. Emergency open repair was performed to remove the IVC filter, the right iliac pseudoaneurysm, and the compromised segments of the iliac veins and IVC with right common iliac artery reconstruction. Staphylococcus aureus was isolated from the tissue culture. The patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after discharge. Six-month follow-up computed tomography revealed that the right common iliac artery was patent, and only mild hydronephrosis was detected.

CONCLUSION

An indwelling IVC filter, even ‘embedded’ within organized thrombus, could still cause life-threatening complications. Open procedures remain the last resort for IVC filters with severe complications.

Keywords: Inferior vena cava filter, Infected pseudoaneurysm, Hydronephrosis, Filter migration, Open repair, Antibiotic therapy, Case report

Core Tip: Few cases are reported about symptomatic penetration caused by double-basket indwelling inferior vena cava (IVC) filter. Herein, we report an unusual case of infected iliac pseudoaneurysm caused by penetration of an indwelling caudal migrated double-basket IVC filter. After open repair and antibiotic therapy, the patient had a good result at 6-mo follow up. This case demonstrated that an indwelling IVC filter in iliocaval confluence, even ‘embedded’ within organized thrombus, could still cause life-threatening complications, and a more aggressive strategy might be necessary for this situation. Open procedures remain the effective treatment for indwelling IVC filters with severe complications.