Inferior vena cava filter (IVCF) is widely used for patients with deep vein thrombosis (DVT) and pulmonary embolism (PE) who are not candidates for anticoagulation which is the preferred
treatment.
The application of IVC filters seems to have decreased over the years. Many complications are associated with IVCF including thrombosis and filter migration into the right atrium, pulmonary artery, right gonadal vein and lumbar veins. We present a case of anuric acute renal failure due to bilateral renal vein thrombosis from IVCF migration.
68 years old male with a past medical history of DVT, PE with IVCF 5 years ago, diabetes mellitus, hypertension, obstructive sleep apnea presented to the emergency department with severe back pain. Patient started to have severe lower back, present throughout the day, constant, non radiating and associated with nausea and vomiting. Patient was noted to have anuria and worsening azotemia. The patient was started on hemodialysis. Further work-up revealed extensive bilateral proximal DVT on Doppler ultrasound. Computerized axial tomography (CT) abdomen showed features of bilateral renal vein thrombosis in the context of IVCF transverse migration occluding both renal veins. Heparin drip was started. The patient underwent an angiogram with thrombectomy. His kidney function and urine output started to improve and the patient was taken off dialysis.
Discussion:
IVCF migration is a rare complication and was reported in minimal number of case reports. A previous case report showed filter migrated to a suprarenal position inside IVC causing bilateral renal vein thrombosis causing acute renal failure. Our case showed migration of IVCF into a transverse position within the renal veins bilaterally resulting in renal shut down.
