Late complication of a Greenfield filter associating caudal migration and perforation of the abdominal aorta by a ruptured strut Ahmad Dabbagh, MD, Nabil.

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Presentation transcript:

Late complication of a Greenfield filter associating caudal migration and perforation of the abdominal aorta by a ruptured strut Ahmad Dabbagh, MD, Nabil Chakfé, MD, PhD, Jean-Georges Kretz, MD, Boualem Demri, PhD, Philippe Nicolini, MD, Claudio Fuentes, MD, Bertrand Mettauer, MD, Eric Epailly, MD, Dominique Muster, MD, PhD, Bernard Eisenmann, MD Journal of Vascular Surgery Volume 22, Issue 2, Pages 182-187 (August 1995) DOI: 10.1016/S0741-5214(95)70115-X Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Plain abdominal radiography performed after insertion of GF in 1986 demonstrates its location at level of first lumbar vertebral body. B, Plain abdominal radiography performed in 1993 demonstrates caudal migration, 30-degree left angulation of GF, and rupture of one of its six struts. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Abdominal computed tomography scan demonstrates perforation of inferior vena cava by struts and perforation of aorta by ruptured strut. A, Hub of filter is left-sided in IVC. B, Angulation of filter to left with perforation of IVC by struts. C, Penetration of aorta by ruptured strut. D, Ruptured strut is free in aortic lumen. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Abdominal computed tomography scan demonstrates perforation of inferior vena cava by struts and perforation of aorta by ruptured strut. A, Hub of filter is left-sided in IVC. B, Angulation of filter to left with perforation of IVC by struts. C, Penetration of aorta by ruptured strut. D, Ruptured strut is free in aortic lumen. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Abdominal computed tomography scan demonstrates perforation of inferior vena cava by struts and perforation of aorta by ruptured strut. A, Hub of filter is left-sided in IVC. B, Angulation of filter to left with perforation of IVC by struts. C, Penetration of aorta by ruptured strut. D, Ruptured strut is free in aortic lumen. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Abdominal computed tomography scan demonstrates perforation of inferior vena cava by struts and perforation of aorta by ruptured strut. A, Hub of filter is left-sided in IVC. B, Angulation of filter to left with perforation of IVC by struts. C, Penetration of aorta by ruptured strut. D, Ruptured strut is free in aortic lumen. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Cavogram demonstrates perforation of IVC by struts and hub of filter. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Aortography demonstrates aortic penetration by ruptured strut without arteriovenous fistula. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Perioperative view of ruptured strut in aortic lumen. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Scanning electron microphotograph of hub of filter. A, Proximal part of ruptured strut is still present in hub. B, At higher magnification, we noted dendritic structure and smooth area. This smooth aspect is probably due to pervious crack during setting and folding process. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Scanning electron microphotograph of hub of filter. A, Proximal part of ruptured strut is still present in hub. B, At higher magnification, we noted dendritic structure and smooth area. This smooth aspect is probably due to pervious crack during setting and folding process. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Scanning electron microphotograph of distal part of ruptured strut. A, About 20% of strut section (arrow) was still connected after setting process. On right side we observed that skin of strut is folded toward central part of section. B, Higher magnification of ruptured area of strut that was still connected after setting process. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Scanning electron microphotograph of distal part of ruptured strut. A, About 20% of strut section (arrow) was still connected after setting process. On right side we observed that skin of strut is folded toward central part of section. B, Higher magnification of ruptured area of strut that was still connected after setting process. Journal of Vascular Surgery 1995 22, 182-187DOI: (10.1016/S0741-5214(95)70115-X) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions