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Case Reports
. 2019 Sep;47(9):4580-4584.
doi: 10.1177/0300060519869453. Epub 2019 Aug 26.

Removal of an inferior vena cava filter that had migrated to the right ventricle by off-pump ventriculotomy and direct-vision snare capture: a novel hybrid technique

Hai Feng  1 , Xueming Chen  1 , Chenyu Li  1 , Zhiwen Zhang  1 , Renming Zhu  1 , Xiaobo Guo  1 , Mingyuan Liu  1
Affiliations
Case Reports

Removal of an inferior vena cava filter that had migrated to the right ventricle by off-pump ventriculotomy and direct-vision snare capture: a novel hybrid technique

Hai Feng et al. J Int Med Res. 2019 Sep.

Abstract

Inferior vena cava filter (IVCF) migration to the right ventricle is a life-threatening condition. Conventionally, on-pump ventriculotomy is required if the endovascular retrieval is compromised. However, for patients in fragile physical condition, the complications of myocardial revascularization are unacceptable. We herein present a case of IVCF migration to the right ventricle in which the hook of the filter was tilted against the anterior wall of the right ventricle. The IVCF was successfully removed via a hybrid technique combining an off-pump microincision of the right ventricle with direct-vision snare capture. This hybrid technique avoided the complication of myocardial revascularization, shortened the operation time, and reduced the amount of blood loss.

Keywords: Inferior vena cava; filter; migration; removal; snare capture; ventriculotomy.

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Figures

Figure 1.
Figure 1.
Preoperative status of the migrated inferior vena cava filter (IVCF) and silicosis of the patient. (a) The initial position of the IVCF (yellow arrow) was under the renal veins. (b) A sagittal chest radiograph showed that the IVCF (yellow arrow) had migrated to the right ventricle. (c) Computed tomography showed that the IVCF was in the right ventricle and that the hook was tilted against the anterior wall of the right ventricle (yellow arrow). (d) A chest radiograph demonstrated stage III silicosis (red arrow) of the patient’s lung.
Figure 2.
Figure 2.
Off-pump extraction of the inferior vena cava filter (IVCF). (a) The anterior wall of the right ventricle was nearly perforated by the hook of the IVCF (yellow arrow). (b) A purse-string suture was placed around the hook (yellow arrow). (c) The hook was captured by a snare (yellow arrow) after making a small incision in the right ventricle. (d) The IVCF was retreated and removed via a 10-Fr sheath (yellow arrow). (e) The IVCF was successfully extracted with a thrombus and the broken filter strut (yellow arrow). (f) The postoperative chest radiograph confirmed complete extraction of the IVCF.
See this image and copyright information in PMC

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