Laser-assisted permanent greenfield filter removal with ileocaval stent reconstruction following filter thrombosis, a case report

Emerging literature supports removal of chronic indwelling IVC filters when they are contributing to complications for a patient and are no longer indicated. We present an interesting case of an elderly patient who had a history of DVT and underwent spinal surgery, which required cessation of his anticoagulation and placement of an IVC filter pre-operatively. Approximately 15 years later the patient presented to our institution with chronic occlusion of his IVC at the level of his filter which had never been removed, with bilateral lower extremity DVT and symptoms of phlegmasia cerulea dolens. Despite a previous unsuccessful attempt at DVT thrombectomy at an outside institution, interventional radiology was consulted, and he subsequently underwent successful laser sheath assisted removal of his 15-year-old permanent Greenfield filter with bilateral lower extremity DVT thrombectomy and venous stenting with significant improvement in his presenting symptoms. Clinical presentation, diagnostic workup, case findings, and outcomes are described.