title: Percutaneous management of extensive clot trapped in a temporary vena cava filter.
abstract: OBJECTIVE
  To present percutaneous management of extensive clot trapped in a temporary inferior vena cava (IVC) filter.
  
  
  METHODS
  A 20-year-old man with a large sacral tumor and left external iliac vein thrombosis had a wire-mounted Günther temporary filter (GTF) prophylactically placed in the infrarenal IVC prior to tumor resection. The 7-day postsurgical venogram prior to filter removal showed extensive clot trapped by the filter, as well as interval cephalic migration, with the filter tip now at the level of the renal veins. A Günther Tulip MReye (GTM) filter was deployed but not released above the renal veins to prevent clot migration during caudal withdrawal of the wire-mounted GTF. After creating enough space in the infrarenal IVC, the GTM was repositioned and fully released with its apex now below the renal veins. The GTF was then uneventfully removed. There was no clinical evidence for significant pulmonary embolism 12 months after placement.
  
  
  CONCLUSIONS
  Cephalic migration of a clotted temporary IVC filter can be managed with intraprocedural protection against pulmonary embolism by first deploying a Günther Tulip filter above the renal veins, with subsequent advancement below the renal veins before temporary filter removal.
authors.affiliation: Department of Diagnostic Imaging/Interventional Radiology, Henry Dynant Hospital, Athens, Greece. vrachliotis2@yahoo.com
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Vrachliotis
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tachtaras
authors.forename: Nicholaos
authors.initials: N
authors.lastname: Doundoulakis
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sheiman
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papadopoulos
authors.forename: Kiriakos A
authors.initials: KA
authors.lastname: Stringaris
mesh_terms: D000328:Adult; D004617:Embolism / Q000628:therapy*; D006801:Humans; D008297:Male; D013997:Time Factors; D016306:Vena Cava Filters