View Abstract

A3357 - Inferior Vena Caval Filter Migration Causing Ileo-Caval Thrombosis, Bilateral Renal Vein Thrombosis and Acute Renal Failure
Author Block: T. Bekker1, G. George2; 1Medicine, Thomas Jefferson University, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Philadelphia, PA, United States.
Introduction: Therapeutic anticoagulation is the preferred management for venous thromboembolic disease. When anticoagulation is not an option, inferior vena cava filters (IVCF) are a safe alternative that can prevent pulmonary embolism. However, IVCF have been associated with complications. We describe a rare complication of IVCF migration and thrombosis leading to acute renal failure needing emergent hemodialysis. Case Description: A 68-year-old obese male with a history of massive pulmonary embolism status-post surgical thrombectomy and deep vein thrombosis status-post temporary IVCF placement, presented with low back pain, lower extremity swelling and decreased urination worsening over five days. He was noted to be in acute renal failure with symptomatic uremia necessitating the initiation of emergent hemodialysis. Lower extremity ultrasound imaging revealed extensive bilateral lower extremity deep vein thrombosis. Computed tomography (CT) of the abdomen and pelvis was notable for a retained IVCF which had migrated superior to level of the renal veins. CT venogram demonstrated extensive ileo-caval thrombosis extending down from the migrated IVCF down to the femoral veins and associated bilateral renal vein thrombosis. A cavogram and bilateral lower extremity venogram was done with subsequent rheolytic thrombectomy and chemical thrombolysis of the inferior vena cava, bilateral iliac and common femoral veins. Valved infusion catheters that extended down from the IVCF down to the popliteal veins were placed bilaterally to continue low dose thrombolysis. Repeat cavogram and venogram was performed the next day and revealed patent veins. The infusion catheters were subsequently removed and anticoagulation with warfarin was initiated. Renal recovery was evident in one week without further need for hemodialysis. The patient followed up as an outpatient and IVCF retrieval by either an endovascular or surgical approach was planned.
Discussion: In venous thromboembolic disease, the indications to use IVCF include the inability to use anticoagulation or failure of anticoagulation. Prophylactic use of IVCF is controversial. When performed, it is important to retrieve the filter given potential complications. These include recurrent pulmonary embolism, IVCF thrombosis, migration, fracture and erosion. In our case, we describe a rare complication of a retrievable IVCF that was retained, causing extensive ileo-caval thrombosis, bilateral renal vein thrombosis and acute renal failure requiring emergent hemodialysis. This was managed with anticoagulation and pharmaco-mechanical thrombolysis treating the acute renal failure and resulting in dialysis independence on discharge.