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Angiogram of retrievable IVC filter placement in inferior vena cava.
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He subsequently developed a deep vein thrombosis during the course of his initial hospitalization and underwent placement of a Cook Celect Platinum filter, a retrievable IVC filter, because of his significant bleeding risk (Fig. 1).
(A and B) Axial and coronal CT views of abdomen and pelvis demonstrating the perforation of retrievable IVC filter tines through IVC into duodenum (yellow arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Once the patient stabilized, his physician ordered computed tomography (CT) scans of the abdomen and pelvis; these revealed an infrarenal IVC filter with tines extending beyond the wall of the inferior vena cava and into the lumen of the distal second and proximal third portion of the duodenum (Fig. 2).
Esophagogastroduodenoscopy (EGD) (multiple views A-C) revealing retrievable IVC filter tines perforating the second portion of duodenum without evidence of bleeding.
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Endoscopic evaluation of the patient showed the retrievable IVC filter tines perforating the second part of the duodenum, although there was no evidence of gross blood (Fig. 3).
Angiogram of retrievable IVC filter being removed. Initially scout film demonstrating the tines extending into the gas filled duodenum (A). The initially contrast study showing no active extravasation from the IVC (B). Completion angiogram after removal of the filter shows no extravasation (C).
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The retrievable IVC filter was successfully retrieved through an endovascular approach and the patient was monitored for bleeding (Fig. 4).