Yonsei Med J.  2017 May;58(3):662-664. 10.3349/ymj.2017.58.3.662.

Pathological Significance of Tissue Trapped in Retrieved OptEase Vena Cava Filter at 18th Day after Installation in Patient with Deep Vein Thrombosis

• Park SM
• Son JW
• Hong KS
• Choi KC

• KMID: 2419128
• DOI: http://doi.org/10.3349/ymj.2017.58.3.662

Abstract

The retrievable type of inferior vena cava filter has been widely used to prevent pulmonary thromboembolism in patients with deep vein thrombosis and contraindication of anticoagulation. Physicians make considerable efforts to remove the filter according to the manufacturer and US Food and Drug Administration safety advisory recommendation. However, forced filter retrieval might cause vascular injury within 3 weeks. Herein, we report pathologic and angiographic findings to suggest filter associated vascular injury during forced retrieval just within recommended period in a patient with deep vein thrombosis.

Keyword

Venous thromboembolism; vena cava; retrieval device

MeSH Terms

Adult
*Device Removal/adverse effects
Disposable Equipment
Endovascular Procedures/instrumentation
Female
Humans
Male
Middle Aged
Pulmonary Embolism/diagnosis/etiology/*prevention & control
Treatment Outcome
*Vena Cava Filters
Venous Thromboembolism/*complications
Venous Thrombosis/complications/diagnosis/*therapy

Figure

• 

  Fig. 1 Tissue trapped in retrieved OptEase filter at 18th day after installation. (A) Gross findings of trapped tissue in the retrieved inferior vena cava filter (arrowheads). (B) Cavography before and after filter removal that shows the mobile rugged filling defects, suggesting vessel wall injuries due to detached filter (circles). (C) Positive immunohistochemical staining for smooth muscle actin (×200) suggesting the smooth muscle cells of caval wall (red arrows and rectangle, ×400). (D) Positive immunohistochemical staining for CD34 (×200) suggesting the endothelial cells of caval wall (blue arrows and rectangle, ×400).

Reference

1. FDA. Removing Retrievable Inferior Vena Cava Filters: FDA Safety Communication. 2014. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm.

2. Foley PJ, Jackson BM, Fairman RM. Pulmonary embolism averted: trapped thrombus in inferior vena cava filters. Circulation. 2012; 126:e38–e39.

3. Van Ha TG, Kang L, Lorenz J, Zangan S, Navuluri R, Straus C, et al. Difficult OptEase filter retrievals after prolonged indwelling times. Cardiovasc Intervent Radiol. 2013; 36:1139–1143.

4. Rimon U, Volkov A, Garniek A, Golan G, Bensaid P, Khaitovich B, et al. Histology of tissue adherent to OptEase inferior vena cava filters regarding indwelling time. Cardiovasc Intervent Radiol. 2009; 32:93–96.