Background: Prolonged dwell time of inferior vena cava (IVC) filter has shown to increase the need for the use of complex IVC filter retrieval techniques. Here we report complex retrieval of IVC filter with prolonged dwelling time which was temporarily associated with severe bradycardia and hypotension.
Case Presentation: 59 years old male patient with past medical history of morbid obesity, atrial fibrillation status post ablation, obstructive sleep apnea and end-stage renal disease presented for IVC filter retrieval. When IVC filter was covered by sheaths and IVC was temporarily collapsed/occluded, the patient developed severe bradycardia and hypotension without compensatory tachycardia. Contrast injection through the common femoral vein sheath showed complete occlusion of IVC while IVC filter was covered by both sheaths likely due to embedment of the IVC filter in the wall by extensive fibrinous tissues. IVF filter was successfully retrieved, and the blood pressure and heart rate were improved immediately afterward. A large non occlusive IVC thrombus was identified on the final venogram, which was aspirated using mechanical thrombectomy device.
Conclusion: Complex retrieval of IVC filter with prolonged dwelled time can result in acute severe bradycardia and hypotension due to vasovagal reaction and/or acute collapse/occlusion of IVC in setting of IVC filter adhesion/embedment in the wall by extensive fibrinous tissues.