Lumbar artery pseudoaneurysm in a patient with inferior vena cava filter and history of strenuous physical exercise Nikolaos Tsekouras, MD, Ralph C.

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Lumbar artery pseudoaneurysm in a patient with inferior vena cava filter and history of strenuous physical exercise Nikolaos Tsekouras, MD, Ralph C. Whalen, MD, Anthony J. Comerota, MD Journal of Vascular Surgery Volume 61, Issue 3, Pages 796-799 (March 2015) DOI: 10.1016/j.jvs.2013.09.057 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Noncontrast computed tomography (CT) image showing a large retroperitoneal hematoma (RH), an area with radiological evidence of a pseudoaneurysm (star), and the inferior vena cava (IVC) filter struts (arrow). Journal of Vascular Surgery 2015 61, 796-799DOI: (10.1016/j.jvs.2013.09.057) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Inferior vena cavagram showing abnormal position of the inferior vena cava (IVC) filter with most of its struts well outside the opacified vena cava lumen, 2 months after the retroperitoneal hematoma (RH) and while removal of the filter was being planned. The filter is severely tilted (arrow) with evidence of external compression of IVC at the filter level (star). B, Computed tomography (CT) image with contrast, 2 months after the retroperitoneal bleeding, showing a large pseudoaneurysm (dashed arrow) displacing the IVC anteriorly. Note the difference in the struts' location (arrow) between Figs 1 and 2 as a result of the pseudoaneurysm exerting pressure on the vena cava. C, Selective lumbar artery arteriogram showing a lumbar artery pseudoaneurysm (loop) and one of the IVC filter's struts adjacent to the lumbar artery (dashed line), most likely the cause of the pseudoaneurysm. Journal of Vascular Surgery 2015 61, 796-799DOI: (10.1016/j.jvs.2013.09.057) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Selective lumbar artery arteriogram showing coiling of the artery (arrow) both proximally and distally to the lacerated area. B, Aortogram showing successful exclusion of the pseudoaneurysm from the systemic circulation. Note the presence of coils (arrow). C, Final cavagram just after successful and uncomplicated lumbar pseudoaneurysm coiling and filter removal. Note the improved vena cava lumen delineation (star). Journal of Vascular Surgery 2015 61, 796-799DOI: (10.1016/j.jvs.2013.09.057) Copyright © 2015 Society for Vascular Surgery Terms and Conditions