Intracardiopulmonary Migration of Inferior Vena Cava Filters: An Updated Systematic Review.

Abstract

Background: Intracardiopulmonary migration of an inferior vena cava (IVC) filter is an uncommon but potentially life-threatening complication. A previous systematic review including data through 2008 found that the most common cause for migration was operator error and that open thoracotomy was the best first option for management.

Objectives: To assess the clinical presentation and causes of intracardiopulmonary filter migration, as well as the most commonly used management strategies over the past 15 years.

Patients and methods: A systematic search of the literature was conducted to identify studies pertaining to intracardiopulmonary IVC filter migration that were published between November 2008 and June 2024, and data were collected regarding clinical presentation, complications, type and location of filter migration, and management strategies.

Results: A total of 156 cases of intracardiopulmonary migration of IVC filters were identified in 88 publications. Of the 66 patients whose symptoms status was listed, 50 patients had symptoms and 16 patients were asymptomatic. In the remaining patients, the symptom status was not listed. The most frequently reported symptom was chest pain (68.0%, 34/50). Of the 156 patients, 34 (22.8%) experienced intracardiopulmonary migration of the entire filter body, and the remaining 122 (78.2%) experienced filter fracture with migration of the fractured struts. Complications were reported in 30.1% of patients (47/156); these complications included myocardial injury (n = 37), damage of tricuspid valve (n = 12), and hemopericardium (n = 21). Endovascular (16 filters and 56 struts) or surgical (13 filters and 16 struts) retrieval was the primary management strategy for intracardiopulmonary migration of the filter or fractured strut.

Conclusion: The main cause of intracardiopulmonary migration of an IVC filter is filter fracture. Endovascular retrieval is gradually becoming the preferred management option for intracardiopulmonary migration of IVC filters.