IVC Filters Causing Perforation of Veins and Organs

IVC filters causing perforation of veins and organs is one of the most severe medical complications that can happen if something goes wrong with an IVC filter. When the vein holding the IVC filter becomes perforated, the walls of the vein become compromised and adjacent organs are put at risk. When the IVC filter also perforates adjacent organs, it can create potentially life-threatening medical conditions. Victims of these situations can pursue compensation for their injuries by filing an IVC filter lawsuit.

ivc filter fracture

1. How IVC filters can perforate veins and organs

IVC filters can perforate the inferior vena cava vein and adjacent organs if the filter fractures, the struts break and migrate, or even if the IVC filter is left implanted for too long.1 In fact, one study found that all surveyed IVC filters that had been left implanted for more than 71 days had perforated the inferior vena cava vein to at least some extent.2

Perforation is not a rare phenomenon: The FDA counted 70 reported instances of IVC filters perforating the inferior vena cava vein between 2005 and 2010.3

IVC filters are tiny implantable devices that look like the frame of an umbrella. On one end of the device, there are a handful of legs, called struts, which can be opened or closed just like an umbrella. On the other end of the device is the head. This is where the struts all join together, making the head look like the handle of the umbrella.

The IVC filter, with its struts closed, is inserted into a patient through a small incision in their neck or groin. Once inside, it is navigated with a catheter to the inferior vena cava vein in the patient's abdomen. This vein is the largest one in the body, and brings blood from the legs up to the heart and lungs. When the filter is in position, the struts are opened to gain a foothold in the interior walls of the inferior vena cava.

The IVC filter stays there to catch blood clots traveling up the inferior vena cava. By keeping these clots from reaching the heart or lungs, the IVC filter prevents potentially fatal pulmonary embolisms.

However, the IVC filter's struts can dig too deeply into the interior walls of the inferior vena cava. This can happen when the IVC filter is first implanted, if the struts open too forcefully, or over time as the patient's heartbeat, breathing, and movements jostle the inferior vena cava and strain the IVC filter.4 If the struts are equipped with hooks to keep the IVC filter from migrating, the odds of perforation and its severity increase significantly.5

If this happens, the IVC filter's struts can create perforations that dent the walls of the vein. These perforations weaken the vein and can be deep enough that they protrude into the organs adjacent to the inferior vena cava. Deep protrusions can create perforations in these organs, as well, leading to other medical complications.

2. Medical complications of a vein or organ perforated by an IVC filter

A vein or organ that has been perforated by an IVC filter can produce a whole host of medical complications, depending on the severity and depth of the perforation and which organ is involved.

When it is only the vein that has been perforated, the medical complications can still be very serious, including:

  • Internal bleeding,
  • Hemorrhaging,
  • Retroperitoneal hematoma, or a swelling of clotted blood behind the peritoneum in the abdomen,
  • Aneurysms in the inferior vena cava, and
  • Cardiac or pericardial tamponade, or heart problems caused by fluid around the heart.

The medical complications of an IVC filter perforation become far more serious when the struts of the filter impact organs that tightly surround the inferior vena cava. These organs include the:

  • Renal pelvis, which is a part of the kidney,
  • Aorta, the largest artery in the body,
  • Lumbar artery, and
  • Duodenum, a part of the small intestine.

In addition to the medical complications that can happen if it is just the inferior vena cava that has been perforated, perforations in any of these organs can cause:

  • Pseudoaneurysms in the lumbar artery6 or in the aorta,7
  • Fistulas with other organs,8
  • Internal bleeding and hemorrhaging, and
  • Chronic abdominal pain.

3. Symptoms of IVC filter perforations

The symptoms of an IVC filter perforating the inferior vena cava or surrounding organs also depend on the severity of the perforation and which organ is involved.

When the IVC filter is only perforating the vein and no organs are implicated, there are usually no symptoms.9 However, when present, symptoms of a perforated inferior vena cava can include10:

  • Long term and progressively worsening abdominal pain,
  • Tenderness in the abdominal region,
  • Nausea,
  • Shortness of breath, and
  • Chronic but intermittent chest pain.

When the IVC filter's struts have perforated both the inferior vena cava vein and adjacent organs, like the duodenum, aorta, or renal pelvis, symptoms can include:

  • Back pain,
  • Abdominal pain, which can be exacerbated by eating or specific movements
  • Nausea, and
  • Vomiting, with blood.

References:

  1. See Durack JC, Westphalen AC, Kekulawela S, Bhanu SB, Avrin DE, Gordon RL, Kerlan RK, “Perforation of the IVC: rule rather than exception after longer indwelling times for the Günther Tulip and Celect retrievable filters,” Cardiovascular Interventional Radiology 35(2):299-308 (April 2012).

  2. Id.

  3. U.S. Food and Drug Administration, “Removing Retrievable Inferior Vena Cava Filters: Initial Communication” (Aug. 9, 2010).

  4. See Grewal S, Chamarthy M, Kalva S, “Complications of inferior vena cava filters,” Cardiovascular Diagnosis and Therapy 6(6):632-41 (December 2016).

  5. Id.

  6. Skeik N, McEachen JC, Stockland AH, Wennberg PW, Shepherd RF, Shields RC, Andrews JC, “Lumbar artery pseudoaneurysm caused by a Gunther Tulip inferior vena cava filter,” Vascular and Endovascular Surgery 45(8):756-60 (November 2011).

  7. Putterman D, Niman D, Cohen G, “Aortic pseudoaneurysm after penetration by a Simon nitinol inferior vena cava filter,” Journal of Vascular and Interventional Radiology 16(4):535-8 (April 2005) and Medina CR, Indes J, Smith C, “Endovascular treatment of an abdominal aortic pseudoaneurysm as a late complication of inferior vena cava filter placement,” Journal of Vascular Surgery 43(6):1278-82 (June 2006).

  8. Franz RW, Johnson JD, Shah KJ, “Symptomatic inferior vena cava perforation by a retrievable filter: Report of two cases and a literature review,” International Journal of Angiology 18(4):203-6 (Winter 2009).

  9. See note 4.

  10. See Unterman S, Nair T, “Perforation of Inferior Vena Cava by Inferior Vena Cava Filter,” Western Journal of Emergency Medicine 14(2):161-2 (March 2013).

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