August 3, 2016 — Dr. Ankit Shah and colleagues at Baylor University published a case report of a 29 year-old female who experienced severe complications after a retrievable IVC filter was left in her body for more than six years.
According to the report (PDF), doctors discovered that two of the G2 filter legs had fractured during an unrelated CT scan. The filter was also tilted more than 15º and perforating her vena cava in several places. She required emergency surgery to remove the filter and its broken pieces.
Her doctors said there was no reason for her to have the filter implanted so long — she could walk, had no evidence of deep vein thrombosis, and only remote bleeding.
In the discussion, researchers blamed her complications on “foreshortening and flattening” of the vena cava.
The vena cava carries a massive amount of blood, but its walls are remarkably thin. It also flexes with every heartbeat. Over time, repetitive movement of the vena cava can eventually weaken and break a metal IVC filter. According to the researchers:
“Transmitted motion can ultimately result in one of two fracture modes: high-cycle metal fatigue secondary to accumulated damage and metal overload sustained from acute stress.”
In May 2014, the FDA recommended removing temporary filters within 29-54 days after implantation. The longer it remains implanted, the higher the risk of severe complications. Unfortunately, many filters are never removed.
In a study of 240 patients who had an IVC filter placed from 2001-2006, only 73 (30.4%) had documented filter retrieval. Of the 62 patients who attempted filter removal, 25.8% of filters could not be successfully removed.
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