Delayed lumbar artery injury caused by a DENALI inferior vena cava filter: a case report

An inferior vena cava filter could reduce only the clinically significant pulmonary embolism rate. Inferior vena cava filter complications include filter fracture, tilt, thrombosis, migration, perforation, and penetration of the placement site or surrounding structures. Nine cases of lumbar artery injury caused by inferior vena cava filters have been reported; however, no cases have been reported in association with DENALI inferior vena cava filters. Herein, we report the case of a patient diagnosed with a retroperitoneal hematoma caused by lumbar artery injury due to a DENALI filter. A 75-year-old woman presented with dyspnea and was diagnosed with pulmonary embolism and deep vein thrombosis. A DENALI inferior vena cava filter was prophylactically implanted. On post-implantation day 34, the patient developed lower back pain and hemorrhagic shock. Contrast-enhanced computed tomography revealed a severe retroperitoneal hematoma anteriorly displacing the right kidney and intestines. Moreover, computed tomography showed deformation and retraction of the DENALI filter, but no arterial extravasation in the arterial and venous phases was present. The patient was diagnosed with IVC injury caused by the DENALI filter. Emergency surgery was performed using a midline incision extending from the upper to the lower abdomen. A significant retroperitoneal hematoma was observed. The inferior vena cava and common iliac veins were clamped, and the inferior vena cava was incised. Upon incision, the DENALI filter was exposed, and its hook was observed to have perforated the inferior vena cava. The DENALI filter was removed. Examination of the dorsal aspect of the inferior vena cava revealed arterial bleeding originating from a lumbar artery. The lumbar artery was repaired, and the procedure was concluded. The postoperative course was complicated by cerebral infarctions but was favorable overall. This report is valuable because it is, to the best of our knowledge, the first report on delayed lumbar artery injury caused by a DENALI filter. Based on our findings, if contrast-enhanced computed tomography shows a massive retroperitoneal hematoma displacing the right kidney and intestines anteriorly along with inferior vena cava filter deformation or retraction, we recommend considering arterial hemorrhage, even if there is no extravasation in the arterial phase.