Abstract
A 43-year-old man with a history of lower extremity deep vein thrombosis presented with facial droop, ataxia, and dysarthria upon waking from a procedure to remove a Bard G2 temporary inferior vena cava (IVC) filter. The filter had been placed at an outside institution 8 years previously at the time of his deep vein thrombosis (DVT). Pre-procedural imaging revealed that the filter had two fractured struts and several of the struts extending outside the wall of the IVC. It was confirmed after removal that two filter struts were missing and a large amount of clot was present on the filter (Panel A-1). Magnetic resonance imaging of the head showed an area of restricted diffusion in the left pons consistent with acute infarct (Panel A-2). A computed tomographic scan of the abdomen showed a strut in the right ventricle, and another in the retroperitoneum abutting the duodenum (Panels A-3 and A-4). A transesophageal echocardiogram revealed an atrial septal aneurysm with a large patent foramen ovale (PFO) and right to left shunting. His large PFO in combination with the periprocedural timing of his symptoms suggest that the stroke was due to paradoxical embolization in the periprocedural setting.
Complications of IVC filters are rare, but can be life-threatening. Complications result from vessel and organ penetration, thrombosis, migration, and strut fracture.1–3 Stroke can occur, as this case illustrates, if a PFO is present. Care should be taken when choosing to place these devices, and alternative therapies should be considered when possible. Filters should be removed when no longer needed, as fracture rates are increased with longer dwell times.1–3 Up to half of complications can be avoided with retrieval within 3 months. 1
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Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.