Repeated Günther Tulip inferior vena cava filter repositioning to prolong implantation time.

A patient presented with iliofemoral deep vein thrombosis, a small pulmonary embolism, and a paradoxic embolus to the axillary artery resulting from a patent foramen ovale (PFO). As prophylaxis against further paradoxic emboli while awaiting percutaneous PFO closure, a Günther Tulip inferior vena cava (IVC) filter was implanted. To prevent incorporation of the IVC filter into the caval wall, it was repositioned twice with use of a filter retrieval set from a transjugular approach. In this way, the implantation time of the filter was extended beyond the recommended period of 10 days. The filter was successfully retrieved 19 days later during percutaneous closure of the PFO.