Spondylodiscitis and psoas abscess as a delayed complication of inferior vena cava filter strut failure. R Ramnarine, M Daneshi, GT Yusuf, H Slim, D Huang.
Spondylodiscitis and psoas abscess as a delayed complication of inferior vena cava filter strut failure R Ramnarine, M Daneshi, GT Yusuf, H Slim, D Huang
No financial disclosures
Clinical History: 68 Year Old Female 2011 Long history of atrial fibrillation.
Suffered a pulmonary embolus followed by pulseless electrical activity arrest.
IVC filter inserted. Converted to oral anticoagulation; subsequent attempts to retrieve the filter failed. Device left in-situ.
Sept 2014 Presented with 1 week history of confusion and backache.
On examination, fever, right flank pain, abnormal liver function tests.
Admitted with presumed biliary sepsis; unresponsive to treatment.
Patient underwent CT imaging to investigate cause of sepsis.
CT Imaging Arrow 1: Right iliopsoas abscess.
Arrow 2: L3/4 infective discitis. 3
Arrow 3: IVC filter strut fracture with perforation through IVC.
2
1
Fig 1: Coronal CT post contrast
CT Imaging
Fig 2: Coronal CT post contraststrut perforation of L3/4 disc space
Fig 3: Volume rendered CT image demonstrating position of filter and perforated strut
Endovascular retrieval of filter body unlikely to be successful and high risk for IVC rupture. Strut not retrievable.
Patient managed with percutaneous (USS guided) drainage of the psoas abscess and intravenous antibiotics.
Fig 4: Axial T1 post contrast MR image demonstrating resolution of psoas abscess but persistent endplate changes and canal stenosis
Discussion (1) IVC filter placement advocated for prophylaxis in patients with high risk of thromboembolic disease.
Complications related to IVC filter insertion1. Procedural related (venous access site) Delayed related; migration, filter fracture, IVC penetration. Retrieval related.
IVC Penetration definition: Society of Interventional Radiology Vein wall penetration by filter strut or anchor device with transmural incorporation
Discussion (2) Asymptomatic IVC penetration occurs in 4 to 38% of patients2. Symptomatic penetration; variation in reported rate 0.4%2 but upto 15%3 in other series.
Studies suggest fewer than 20% of filters are retrieved3,4. Example reported complications: Pancreatitis secondary to IVC penetration by filter5. Aortic, ureteral, duodenal penetration6,7,8. Aortic pseudoaneurysm9. Lumbar artery pseudoaneurysm/laceration10,11.
Conclusion IVC filter placement and subsequent IVC penetration can lead to serious complications.
Complications can be difficult to manage and require multidisciplinary input.
The use of temporary filters and timely retrieval is universally advocated to reduce the risk of IVC penetration.
There are some groups advocating serial CT follow-up of patients with filters in-situ particularly if longterm or known asymptomatic penetration.
References 1.
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Amole AO et al. Lumbar artery laceration with retroperitoneal haematoma after placement of a G2 inferior vena cava filter. Cardiovasc Intervent Radiol 2008; 31(6): 1257-9.