52-year-old male with IVC occlusion by TRAPEASE filter place | Figure 1

yitzchakdavid
Registered Nurse

Case Overview

52-year-old male with IVC occlusion by TRAPEASE filter placed 25 years prior prophylactically because of traumatic accident. IVC flow re-established with overlapping WALLSTENTs in a "two tunnel" fashion. Patient placed on anticoagulant and discharged.

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Large adrenal met causing compression of the IVC s/p IVC revision. Wallflex Stent was placed in the infrahepatic IVC with good result. Improved patients bilateral lower extremity symptoms and discharged same day.

IVC filter placed after patient came in with #Pulmonary-embolism.

The patient had a previously placed IVC filter with many anterior limbs with possible extension through the IVC and into the duodenum with ascending colonic wall thickening and surrounding fat stranding raising concern for occult traumatic injury related to IVC filter limbs. The treatment options included endoscopic to verify bowel penetration with endovascular versus surgical removal. Since the patient was hemodynamically stable, a conservative approach was used. Initial attempts using loop snare technique, endobronchial forceps, and a goose neck snare were unsuccessful. Ultimately, obtaining jugular and femoral access and flipping the IVC filter resulted in successful removal. Anyone else have success using the flipping technique for IVC filter removal? Case courtesy of Drs. Cosette Stahl and Hamed Aryafar from the UCSD Medical Center - Dept of Radiology.

Focus on anatomy here. What is the anomaly? A give away follow up question, where would you place an IVC Filter?

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