Endovascular management of an inferior vena cava (IVC) filter penetration and related lumbar artery pseudoaneurysm in an elderly patient

Retrievable filters of Inferior vena cava (IVC) are used to prevent venous thromboembolism (VTE) in high-risk patients, but can result in rare and serious complications like filter penetration into adjacent structures leading to pseudoaneurysm formation. We present a unique case of an 87-year-old male patient with a history of bilateral lower limb deep vein thrombosis (DVT) who developed a large pseudoaneurysm of the third right lumbar artery following prophylactic IVC filter placement before femoral neck fracture surgery. The patient was re-admitted after he experienced dull abdominal pain in the periumbilical region for three days before admission. Abdominal Doppler ultrasound and CT angiography identified an abdominal hematoma and a third right lumbar artery pseudoaneurysm. Angiography confirmed a large pseudoaneurysm resulting from the IVC filter penetration. Endovascular treatment with coil embolization was successfully performed to exclude the pseudoaneurysm. However, the filter could not be retrieved due to the incorporated strut penetration into the IVC wall. The patient had recovered without any complications. He was discharged with therapeutic anticoagulation. This case highlights the importance of anticipating potential complications with indwelling IVC filters, as well as the implications for management in elderly patients undergoing major surgeries.