Inferior vena cava filter limb embolization to the right ventricle: a case report

Background: Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE) in patients at a high risk for venous thromboembolism with a contraindication to anticoagulation. Inferior vena cava filters are associated with rare but significant long-term complications such as filter fracture and embolization. 

Case summary: We report the case of a 53-year-old female with an IVC filter inserted 8 years back for the management of recurrent bilateral PE resistant to anticoagulation. Imaging revealed an incidental finding of IVC filter limb fracture and migration to the right heart and the hepatic and renal veins. The patient remained asymptomatic with no impairment in cardiac, liver, or renal function. Due to a high operative risk, the broken IVC filter and embolized filter limbs were not retrieved. 

Discussion: There is no consensus on the management of intracardiac embolization of IVC filters. Intravascular fragments may be removed by endovascular or surgical approaches, depending on the anatomical location. Following IVC filter insertion, an appropriate follow-up must be put in place to ensure removal and limit clinical sequelae that are otherwise avoidable. A multidisciplinary approach to the management of IVC filter fracture and embolization is recommended.