Penetration of inferior vena cava filter strut through an introducer sheath inserted from the left internal jugular vein: An anatomical pitfall.

The report describes a case of penetration of an inferior vena cava filter (IVCF) strut through an introducer sheath inserted from the left internal jugular vein. A 64-year-old woman was admitted to our hospital with pulmonary embolism and lower extremity deep vein thrombosis. We attempted to implant a retrievable type IVCF via the left internal jugular vein. However, an unexpected resistance occurred during the advancement of the filter after passing the first few inches within the 8-Fr introducer sheath. Immediately, we checked the insertion site using fluoroscopy, which demonstrated penetration of the filter struts to the outside of the sheath. We speculate that a strong angulation in the vessel from the left internal jugular to superior vena cava might have contributed to this rare complication. <Learning objective: Penetration of an inferior vena cava filter (IVCF) strut through an introducer sheath is a rare complication. However, physicians should recognize that this complication could occur in cases of IVCF placement, especially when insertion is done via the left internal jugular vein.>.