A systematic review of cases of aortic penetration by inferior vena cava filters.

OBJECTIVE

To assess the clinical presentation of aortic penetration by inferior vena cava (IVC) filters, as well as common management strategies and clinical outcomes.

METHODS

A systematic search of the literature was conducted to identify studies pertaining to aortic penetration by IVC filters published between January 1967 and April 2025.

RESULTS

A total of 35 reports regarding aortic penetration by IVC filters were identified, including a total of 53 patients and 11 types of IVC filters. The median time from filter placement to the diagnosis of aortic penetration was 5.0 years (interquartile range: 1.7, 8.0 years). Of the 53 patients, 28 (52.8%) were symptomatic, 19 (35.9%) were asymptomatic, and 6 (11.3%) had unknown symptomatology. The most frequently reported symptom was abdominal pain (30.2%). Fifteen patients were reported to have experienced one or more of the following complications: aortic pseudoaneurysm (n = 7), arterial thrombosis (n = 5), retroperitoneal hematoma (n = 4), arteriovenous fistula (n = 2), and aortic dissection (n = 1). Of the 53 patients, 36 (67.9%) underwent filter retrieval (endovascular retrieval, n = 24; surgical retrieval, n = 12), 9 (18.0%) underwent repair of the perforated aorta without filter removal, 6 (11.3%) received conservative management, and 2 (4.0%) died of retroperitoneal hematoma.

CONCLUSIONS

Aortic penetration by IVC filters is uncommon but potentially life-threatening. Symptomatic patients account for nearly half of all penetrations. For patients demonstrating concomitant penetration into adjacent tissues or visceral organs, surgical retrieval may provide the best option. In asymptomatic patients with no radiologically evident concomitant injuries, endovascular retrieval has been demonstrated to serve as a relatively safe and feasible alternative management strategy.