PMC4857299_01
(a) The inferior vena cava filter in the right ventricle was pulled from the right and left femoral veins using a guide wire, although the filter was lodged in the tricuspid valve and could not be removed. (b) The filter in the right ventricle was pulled cranially from the right cubital and internal jugular veins using the jugular or cubital wire loop. (c) The filter was passed through the tricuspid valve. The arrows indicate the direction of the force applied by the guide wire, and the arrowheads indicate the deformed structure of the filter.
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However, the filter was lodged in the tricuspid valve, and we failed to remove the filter from the RV (Figure 1(a)). We also inserted an Amplatz Goose Neck Snare (Covidien plc., Dublin, Ireland) using a 6-Fr Mach 1 Femoral Curved Right 4.0 guide catheter (Boston Scientific Corp., Natick, MA) from the right internal jugular vein and held the guide wire using the Goose Neck Snare (Figure 1(b)). The filter was pulled cranially using the jugular or cubital wire loop, which successfully removed it from the RV, although this action deformed the filter (Figure 1(c)).
(a) The deformed inferior vena cava filter was located above the common iliac vein bifurcation. (b) A second filter was implanted over the deformed filter to prevent recurrent pulmonary embolism. (c) A venography revealed that the second filter was located below the renal veins. The arrows indicate the bilateral renal veins, and the arrowheads indicate the deformed structure around the hook of the filter.
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We then pulled the filter from the femoral veins using the original Radifocus stiff guide wire, and the filter subsequently became positioned in the lower IVC immediately above the iliac venous confluence (Figure 2(a)). However, we could not retrieve the filter because it was deformed, especially around the hook (Figure 2(a)). Therefore, we implanted a second filter between the renal veins and the first filter to prevent recurrent PE (Figure 2(b) and (c)).