Endovascular Stent Graft Repair of an Inferior Vena Cava Pseudoaneurysm After Complex Inferior Vena Cava Filter Retrieval

Purpose: Active extravasation after inferior vena cava (IVC) filter retrieval is a rare complication usually managed by conservative means. We present an endovascular technique used for IVC repair of a bleeding pseudoaneurysm in a patient who was a poor surgical candidate.

Materials and Methods: A 62-year-old woman with a history of orthotopic liver transplantation and an indwelling IVC filter 9 years earlier was referred for complex filter retrieval. After unsuccessful attempts at retrieval using a snare and a rigid forceps, a laser sheath was used to free the endothelialized tines of the filter. Venogram after filter retrieval showed a wide-necked IVC pseudoaneurysm, which was managed by prolonged balloon tamponade using an Amplatz sizing balloon with a decrease in size of the pseudoaneurysm and absence of active extravasation. Overnight the patient started bleeding and became hypotensive. Computed tomography (CT) showed a large retroperitoneal hematoma with active extravasation from a patent IVC pseudoaneurysm. The patient was brought to the interventional radiology suite, and a 26- ´ 39-mm Zenith endograft was deployed via the right femoral vein to exclude the wide-necked pseudoaneurysm. The patient had no further bleeding, and CT performed 2 years later showed complete resolution of the pseudoaneurysm with a widely patent stent.

Results: An aortic endograft was used to successfully repair a bleeding IVC pseudoaneurysm in this case with good long-term patency.

Conclusions: IVC pseudoaneurysms are rare occurrences most often managed by conservative means or surgery. This case demonstrates that endovascular repair may be a viable treatment option in nonsurgical candidates.