Surgical Management of Perforated Inferior Vena Cava Filters.

Background: Management of complicated indwelling inferior vena cava (IVC) filters has increased due to low retrieval rates. Filter migration and perforation are infrequent complications and require explantation of the filter. We report our recent experience with endovascular retrieval and surgical explantation of IVC filters after caval perforation.

Methods: This is a retrospective review of patients who had IVC filter explantation between 2014 and 2015. Patient demographics, indication for filter placement, clinical presentation, surgical indication and technique, and outcomes were noted.

Results: Five cases of IVC filter removal due to caval perforation were identified. Four patients were female, and the median age was 50. Four IVC filters were of the retrievable type and had an average indwelling time of 4 years. One filter was permanent with an indwelling time of 9 years. The most common presentation was abdominal pain. Four patients had an open operation: 2 performed via laparotomy and 2 with retroperitoneal exposure of the IVC. One patient required median sternotomy and explantation of device fragments that migrated to the right ventricle. One patient had endovascular retrieval, with filter indwelling time of 0.8 years. No mortality occurred related to device removal. All patients had resolution of pain at their postoperative visit.

Conclusions: Patients presenting with abdominal pain and history of IVC filter placement should cause concern for possible caval strut perforation. Endovascular retrieval or surgical explantation are required for removal and can be accomplished with minimal risk to the patient.