Delayed retroperitoneal arterial hemorrhage after inferior vena cava filter deployment

RATIONALE Pulmonary embolization is a life-threatening condition. The deployment of inferior vena cava (IVC) filter is the first choice for preventing embolus from the lower extremity. However, IVC filter complications are rare but not to be neglected. Penetration of the arterial wall may result in catastrophic damages. This case report describes a woman who suffered from retroperitoneal hemorrhage after placement of an IVC filter due to a pulmonary embolization. Her filter was found to have penetrated the right lumbar artery and caused the massive bleeding. She was successfully treated with endovascular coil embolization. PATIENT CONCERNS A 47-year old woman presenting with pulmonary embolization was admitted to our hospital. An IVC filter was deployed. Twenty days after her operation, she suffered from an intolerable lumbago when bending over. Contrast-enhanced computed tomography at the local hospital showed a massive retroperitoneal hematoma adjacent to the IVC filter. DIAGNOSES Contrast-enhanced CT at the local hospital showed a massive retroperitoneal hematoma adjacent to the IVC filter. Thereafter, she was transferred to our hospital. Her hemoglobin and INR were 7.1 g/dl and 3.4, respectively. Her systolic blood pressure decreased to 70 mmHg with heart rate increasing to 110 beats/min. The shock index was greater than 1.5. INTERVENTIONS Angiography of the abdominal aorta showed extravasation of contrast medium from the right third lumbar artery. Embolization of the lumbar arteries was performed with coils. OUTCOMES Several days later, she recovered with hematoma shrinking in size and was discharged from the hospital with stable condition. LESSONS It highlights that appropriate monitoring of patients with IVC filters is an essential part during the long-term management. Endovascular treatment showed a safe and effective way to treat arterial perforation caused by hooks of inferior vena cava filters.