Intracardiac Embolization of Inferior Vena Cava Filter

Abstract

The usage of inferior vena cava filters (IVCFs) is recommended for thromboembolic disease and has increased during the past few years, mainly for preventing pulmonary embolism (PE). Inferior vena cava filter complications might be late or due to its insertion and even to its removal. Misplacement of the device is another potential complication of its use. These complications are incident in about 3–12% of the patients, although filter embolization/complete migration is extremely rare. The intracardiac embolization is a potentially serious condition that must be promptly managed. Knowing that patients who had undergone IVCF insertion are indeed at risk for thromboembolic events, diseases that share the same physiopathology should be listed as possible diagnosis, especially when it comes to chest pain. It is essential that myocardial infarction (MI) and PE are excluded as soon as possible; therefore, in addition to the examinations such as cardiac enzymes and electrocardiogram, among others exams, the first diagnosing exam that should be performed is the transthoracic echocardiogram. In the presence of intracardiac embolization of the IVCF, between the treatment options, the best approach would be the thoracotomy (open heart surgery), although there is no strong evidence to support one approach over the other, due to the low incidence of this condition. Besides that, the removal of the filter by thoracotomy puts the patient at risk as well as other types of cardiac surgery.