Description of Event or Problem · 1
THE FILTER WAS NOT TILTED. THERE WAS A MINIMAL RETAINED CLOT IN THE FILTER. THE MULTI-SIDE HOLE STRAIGHT CATHETER AND SHEATH WERE REMOVED OVER AN AMPLATZ WIRE. THE 11/9 FRENCH SHEATHS WERE ADVANCED OVER THE AMPLATZ WIRE AND PLACED JUST ABOVE THE LEVEL OF THE IMPLANTED FILTER. THE AMPLATZ WIRE WAS REMOVED AND THE SNARE OF THE BARD FILTER RECOVERY KIT WAS INSERTED. THE HOOK OF THE WIRE WAS SNARED. THE FILTER COLLAPSED BY ADVANCING THE 9 FRENCH SHEATH OVER IT. THE FILTER, THE SNARE, AND 9 FRENCH SHEATH WERE REMOVED. OMNIPAQUE 350 (10 ML) WAS INJECTED THROUGH THE REMAINING SHEATH. DIGITAL SUBTRACTION IMAGES WITH ATTENTION TO THE INFERIOR VENA CAVA WERE OBTAINED. NO CAVAL INJURY WAS NOTED. INSPECTION OF THE FILTER DEMONSTRATED THAT ONE OF THE SMALLER STRUTS WAS MISSING. A PHOTO SPOT IMAGE OF THE INFERIOR VENA CAVA CONFIRMED THAT THE STRUT REMAINED IN PLACE. ATTEMPTS TO RETRIEVE THE STRUT USING A 25 MM SNARE WERE UNSUCCESSFUL IN LARGE PART DUE TO THE INABILITY TO CONSISTENTLY VISUALIZE THE STRUT DUE TO THE PATIENT'S SIZE. ADDITIONAL PHOTO SPOT IMAGES WERE OBTAINED DURING THE RETRIEVAL ATTEMPT TO ESTABLISH THE ORIENTATION OF THE STRUT. THE 11 FRENCH SHEATH WAS REMOVED AND HEMOSTASIS ESTABLISHED WITH MANUAL COMPRESSION. NO ADDITIONAL IMMEDIATE COMPLICATION WAS OBSERVED. SUBSEQUENT CT POST RETRIEVAL: THE RETAINED STRUT IS ORIENTED OBLIQUELY WITHIN THE INFRARENAL IVC. IT'S NOT CLEAR WHETHER THE LOWER END OF THE STRUT IS EMBEDDED INTO THE CAVAL WALL. NO ADDITIONAL FINDINGS SUGGESTING CAVAL INJURY IDENTIFIED. A FOLLOW-UP STUDY WILL BE PERFORMED TO REASSESS THE STRUT POSITION.FOLLOW UP CT: STABLE POSITION OF RETAINED IVC FILTER STRUT WITHIN THE INFRARENAL IVC AS DESCRIBED. I FEEL THAT THIS STRUT IS RETRIEVABLE.NO OTHER INFORMATION AVAILABLE.