Inferior Vena Cava Filter Perforates and Leads to Below-Knee Amputations

This case involves a thirty-two-year-old male who was scheduled for a gastric bypass surgery. The patient had a Bard Recovery Filter, a type of IVC catheter filter, placed prophylactically to prevent the propagation of clots to the lungs and heart. Such precautionary measures were undertaken due to the patient’s increased risk for deep venous thrombosis (DVT). Sometime after the IVC filter was placed, the patient experienced severe bilateral lower extremity swelling and pain. A CT scan of the abdomen and pelvis showed the IVC filter had several prongs extending outside of the vascular lumen of the inferior vena cava. As a result of the perforation of the vena cava by the IVC filter, the patient suffered DVT and complete thrombosis and occlusion of the inferior vena cava, pelvic veins, and lower extremities bilaterally resulting in phlegmasia (or inflammation of the vasculature) and lower extremity ischemia requiring bilateral below-knee amputations.

Question(s) For Expert Witness

1. Is it possible for an IVF filter to perforate the IVC? If so, what complications can be expected?

Expert Witness Response

It is proposed the global stressors of the respiratory and cardiac cycles of the human body cause the IVC filter to develop stress or “fatigue” fractures of the Nitinol (the material of which its made) surface of the device. This results in fracture of one or more of the struts of the device. The struts will then become embedded in the anatomy, causing perforation. The IVC is a very large vein that carries blood back to the heart from the lower extremity. Impediment of venous return can lead to engorgement of the lower extremities, leading to serious complications.