Endovascular retrieval of bone cement entrapped in an inferior vena cava filter after percutaneous vertebroplasty: a case report

Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures, however, bone cement leakage may enter the venous system and cause potentially serious embolic complications. Entrapment of migrated bone cement within an inferior vena cava filter (IVCF) is rare and may pose substantial technical challenges during filter retrieval. We report the case of a 67-year-old woman with bilateral deep vein thrombosis who underwent placement of a Denali retrievable IVCF after thrombus progression while receiving a nonstandard initial rivaroxaban regimen selected because of concern about bleeding risk. She subsequently underwent PVP for osteoporotic thoracolumbar compression fractures and returned 5 months after filter placement for elective retrieval. Pre-retrieval ultrasonography showed a patent inferior vena cava (IVC) but did not identify the intrafilter abnormality. Intraoperative inferior vena cavography revealed an obvious filling defect within the IVCF. A radiopaque shadow on fluoroscopy and retrospective review of prior PVP images suggested an impacted bone cement foreign body. Conventional retrieval through the right internal jugular vein failed. After reassessment of the procedural risks and discussion with the patient and her family, a 22F large-bore sheath was introduced through the femoral vein, and a temporary protective IVCF was deployed in the infrarenal IVC, caudal to the renal vein ostia and cephalad to the mobilized Denali filter–cement complex. The Denali retrievable IVCF and entrapped bone cement were retrieved en bloc through femoral venous access, and the protective filter was subsequently removed using the LOOP technique. The patient remained hemodynamically stable and had no fever, chest tightness, dyspnea, or abdominal pain. Follow-up computed tomography showed no hematoma, IVC stenosis, or IVC occlusion, and she was discharged in stable condition. This case highlights that, in patients with a history of PVP and an indwelling IVCF, intrafilter bone cement entrapment should be considered before planned filter retrieval. Careful review of previous fluoroscopic or interventional images, preoperative abdominal radiography followed by selective IVC CT venography (CTV) when radiopaque material is suspected, routine intraoperative cavography, preparation of large-bore sheaths and protective filters, and readiness for open surgical conversion may improve procedural safety.