Leonardo Rufino Garcia, MD¹

André Monti Garzesi, MD¹

Elvis Aaron Porto, MD¹

Diego Pretel, MD¹

Antonio Sérgio Martins, MD, PhD¹

Marcone Lima Sobreira, MD, PhD¹

Flavio de Souza Brito, MD, PhD¹

Marcello Laneza Felicio, MD, PhD¹

1.Department of Surgery, Universidade Estadual Paulista - UNESP, Botucatu, SP, Brazil

Corresponding author:

Leonardo Rufino Garcia, MD.

Department of Surgery, Universidade Estadual Paulista – UNESP

Av. Mário Rubens Guimarães Montenegro, Botucatu, SP, Brazil

55 14 3880-1547

Zip Code 18618-687

lrufinogarcia@gmail.com

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We declare no financial support.

Patient has signed informed consent.

International Review Board/ Clinical Trial Registration: N/A

Patients with venous thromboembolism and absolute contraindication to anticoagulation may benefit from inferior vena cava filter (IVCF) placement^1,2. These devices can be permanent or retrievable. Complications associated with its placement are well known and more common with not retrieved devices³.

In this way, we show a case of a 47-year-old woman, in follow-up with gynecology because of abnormal uterine bleeding due to uterine myomatosis. Three days after IVCF implantation because of previous deep vein thrombosis she presented with tachycardia, hypotension, and hemodynamic instability. After chest tomography to confirm the hypothesis of pulmonary thromboembolism, the medical team verified that the device had migrated to the right atrium (fig.1A), with punctual perforation (fig.1B).

She underwent cardiac surgery with medium sternotomy, bicaval cannulation, and cardiopulmonary bypass for device resection via right atriotomy. Large clots and the filter were removed (fig.1C). The patient was weaned from cardiopulmonary bypass and is currently in postoperative recovery. In figure 1D we can see the vena cava filter with some clots after removal. Assistant physicians must keep in mind this potentially fatal complication, particularly when filter retrieval is not feasible.