Surgical Removal of a Günther Tulip Filter With Symptomatic Caval Penetration After Unsuccessful Percutaneous Retrieval

We report a case involving the surgical removal of a Günther Tulip filter with symptomatic caval penetration after an unsuccessful attempt at percutaneous retrieval in a 32-year-old man with recurrent deep vein thrombosis. He presented with acute right flank pain a day after the attempted retrieval of the filter. An abdominal radiograph before surgical removal of the filter showed tilting and splaying of the filter, which was suggestive of caval penetration. Contrast-enhanced computerized tomography confirmed caval penetration of the filter legs into the retroperitoneal space, right renal vein, and duodenum associated with a small retroperitoneal fluid collection. Surgical removal of the filter by a transperitoneal approach resulted in resolution of the flank pain.