Skip to main content

Delayed retroperitoneal arterial hemorrhage after inferior vena cava (IVC) filter insertion: Case report and literature review of caval perforations by IVC filters


Transvenous placement of inferior vena cava (IVC) filters has become commonplace in selected patients with deep venous thrombosis (DVT) and pulmonary embolism (PE). IVC filters have been shown to have excellent therapeutic efficacy and low complication rates. Penetration of the IVC by filter hooks or struts has been reported and commonly noted to be inconsequential We report a laceration of a lumbar artery by a stainless steel Greenfield (SSG) filter strut that resulted in a near fatal hemorrhage, and review the world literature on caval perforation by IVC filters.

This is a preview of subscription content, access via your institution.


  1. 1.

    Athanasoulis CA, Kaufman JA, Halpern EF et al.. Inferior vena caval filters: review of a 26-year single-center clinical experience. Radiology 2000; 216: 54–66.

    PubMed  CAS  Google Scholar 

  2. 2.

    Streiff MB. Vena caval filters: a comprehensive review. Blood 2000; 95: 3669–3677.

    PubMed  CAS  Google Scholar 

  3. 3.

    Greenfield LJ, Proctor MC. Twenty-year clinical experience with the Greenfield filter. Cardiovasc Surg 1995; 3: 199–205.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Ray CE Jr, Kaufman JA. Complications of inferior vena cava filters. Abdom Imaging 1996; 21: 368–374.

    PubMed  Article  Google Scholar 

  5. 5.

    Decousus H, Leizorovicz A, Parent F et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis N Engl J Med 1998; 338: 409–415.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Howerton RM, Watkins M, Feldman L. Late arterial hemorrhage secondary to a Greenfield filter requiring operative intervention. Surgery 1991; 109: 265–268.

    PubMed  CAS  Google Scholar 

  7. 7.

    Proctor MC, Greenfield LJ, Cho KJ et al. Assessment of apparent vena caval, penetration by the Greenfield filter. J Endovasc Surg 1998; 5: 251–258.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Greenfield LJ, Zocco J, Wilk J, et al. Clinical experience with the Kim-Ray Greenfield, vena caval filter. Ann Surg 1977; 185: 692–698.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Wojtowycz MM, Stoehr T, Crummy AB, et al. The Bird's Nest inferior vena caval filter: review of a single-center experience. J Vasc Interv Radiol 1997; 8: 171–179.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Chintalapudi UB, Gutierrez OH, Azodo MV. Greenfield filter caval perforation causing an aortic mural thrombus and femoral artery occlusion. Cather Cardiovasc Diagn 1997; 41: 53–55.

    Article  CAS  Google Scholar 

  11. 11.

    Kurgan A, Nunnelee JD, Auer AI. Penetration of the wall of an abdominal aortic aneurysm by a Greenfield filter prong: a late complication. J Vasc Surg 1993; 18: 303–306.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Goldman HB, Hanna K, Dmochowski RR. Ureteral injury secondary to an inferior vena caval filter. J Urol 1996; 156: 1763.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Flanagan D, Creasy T, Charaway F et al. Caval umbrella causing obstructive uropathy. Postgraduate Medical Journal 1996; 72(846): 235–237.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Sarkar MR, Lemminger FM. An unusual cause of upper gastrointestinal haemorrhage—perforation of a vena cava filter into the duodenum. Vasa 1997; 26: 305–307.

    PubMed  CAS  Google Scholar 

  15. 15.

    Bianchini AU, Mehta SN, Mulder DS et al. Duodenal perforation by a Greenfield filter: endoscopic diagnosis. Am J Gastroenterol 1997; 92: 686–687.

    PubMed  CAS  Google Scholar 

  16. 16.

    Taheri SA, Kulaylat MN, Johnson E, et al. A complication of the Greenfield filter: fracture and distal migration of two struts—a case report. J Vasc Surg 1992; 16: 96–99.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Zahrani HAA. Bird's nest inferior vena caval filter migration into the duodenum: a rare cause of upper gastrointestinal bleeding. J Endovasc Surg 1995; 2: 372–375.

    PubMed  Article  Google Scholar 

  18. 18.

    Dardik A, Campbell KA, Yeo CJ, et al. Vena cava filter ensnarement and delayed migration: an unusual series of cases. J Vasc Surg 1997; 26: 869–874.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Alik Faber.

About this article

Cite this article

Woodward, E.B., Faber, A., Wagner, W.H. et al. Delayed retroperitoneal arterial hemorrhage after inferior vena cava (IVC) filter insertion: Case report and literature review of caval perforations by IVC filters. Annals of Vascular Surgery 16, 193–196 (2002).

Download citation


  • Inferior Vena Cava
  • Inferior Vena Cava Filter
  • Inferior Vena Cava Filter Placement
  • Inferior Vena Cava Wall
  • Greenfield Filter