Knox Abbey, Gimpel Damian, Harjit Singh Rajinder Singh, Burdeniuk Christine, Bennetts Jayme S
Department of Cardiothoracic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia.
Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia.
Eur Heart J Case Rep. 2022 Sep 20;6(9):ytac378. doi: 10.1093/ehjcr/ytac378. eCollection 2022 Sep.
Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE) in patients at a high risk for venous thromboembolism with a contraindication to anticoagulation. Inferior vena cava filters are associated with rare but significant long-term complications such as filter fracture and embolization.
We report the case of a 53-year-old female with an IVC filter inserted 8 years back for the management of recurrent bilateral PE resistant to anticoagulation. Imaging revealed an incidental finding of IVC filter limb fracture and migration to the right heart and the hepatic and renal veins. The patient remained asymptomatic with no impairment in cardiac, liver, or renal function. Due to a high operative risk, the broken IVC filter and embolized filter limbs were not retrieved.
There is no consensus on the management of intracardiac embolization of IVC filters. Intravascular fragments may be removed by endovascular or surgical approaches, depending on the anatomical location. Following IVC filter insertion, an appropriate follow-up must be put in place to ensure removal and limit clinical sequelae that are otherwise avoidable. A multidisciplinary approach to the management of IVC filter fracture and embolization is recommended.
下腔静脉（IVC）滤器用于预防静脉血栓栓塞高风险且有抗凝禁忌证患者的肺栓塞（PE）。下腔静脉滤器与罕见但严重的长期并发症相关，如滤器断裂和栓塞。
我们报告一例53岁女性病例，该患者8年前因复发性双侧抗凝治疗无效的肺栓塞而植入下腔静脉滤器。影像学检查偶然发现下腔静脉滤器肢体断裂并迁移至右心以及肝静脉和肾静脉。患者无症状，心脏、肝脏或肾功能无损害。由于手术风险高，未取出断裂的下腔静脉滤器和栓塞的滤器肢体。
对于下腔静脉滤器心脏内栓塞的处理尚无共识。血管内碎片可根据解剖位置通过血管内或手术方法取出。植入下腔静脉滤器后，必须进行适当的随访，以确保取出滤器并限制原本可避免的临床后遗症。建议采用多学科方法处理下腔静脉滤器断裂和栓塞。
