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Surgical Management And Multispecialty Involvement In The Removal Of Eroded Inferior Vena Cava Filters
Peter Z. Berger, MD, MPH, Robert Barghout, MD, Edward Andraos, MD, Jacob Schwartzman, MD, MPH, Andre Critsinelis, MD, Micheal Ayad, MD.
Mount Sinai Medical Center, Miami Beach, FL, USA.
OBJECTIVES: Indwelling inferior vena cava (IVC) filters may fracture, migrate, or erode into surrounding structures when left in place for an extended period. These devices are commonly removed through endovascular techniques. However, open surgery is sometimes required to remove indwelling filters that have become incorporated into the IVC or surrounding structures. The purpose of this study was to identify the variety of institutional resources that were needed in the care of these patients at a single center over a two-year period.
METHODS: Hospital records for six patients who underwent surgical removal of an IVC filter at a single community teaching hospital between May of 2022 and June of 2024 were reviewed.
RESULTS: Three patients were male (50%), the mean age was 48 years old (range 31-63 years), and the removed filters had been in place an average of 8.7 years (range 4-13 years). All patients had invasion of filter struts into surrounding structures including the duodenum (83%), aorta (83%), pancreas (33%), and right ureter (17%). Patients presented with a variety of symptoms including abdominal pain (17%), painless hematuria (17%), and one case of symptomatic IVC occlusion requiring preoperative thrombolysis. Primary repair of the IVC and relevant adjacent structures was performed in five patients while one patient required a bovine pericardial patch for caval reconstruction. All cases of duodenal or pancreatic erosion involved a hepatobiliary surgeon who primarily repaired these structures. Mean length of stay was 9 days (range 4-15 days) and there were no mortalities. Several in hospital complications occurred requiring subspecialist consultation. One patient developed cardiogenic shock requiring pulmonary embolectomy and initiation of VA-ECMO. One patient required a right ureteral stent for retroperitoneal hematoma causing ureteral compression with hydronephrosis. One intraoperative complication occurred, a common bile duct injury that required primary repair over a T-tube.
CONCLUSIONS: The surgical removal of eroding IVC filters often requires repairing structures adjacent to the IVC. An interdisciplinary approach is likely to improve outcomes for these complex patients. The availability of subspecialty services such as hepatobiliary surgery, urology, and cardiothoracic surgery should be considered when evaluating patients for surgical removal of an IVC filter.
Surgical IVC Filter Removal Case Details| Case Number | Sex | Age | Years with Filter | LOS (days) | Consulting Services |
| 1 | F | 43 | 13 | 4 | Hepatobiliary |
| 2 | M | 49 | 13 | 15 | Cardiothoracic |
| 3 | F | 63 | 11 | 8 | Hepatobiliary, Urology |
| 4 | F | 31 | 5 | 7 | Hepatobiliary |
| 5 | M | 61 | 4 | 10 | Hepatobiliary |
| 6 | M | 41 | 6 | 10 | Hepatobiliary, Urology |
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