Inadvertent cannulation of the right gonadal vein can occur while inserting IVC filter

Q: Inadvertent cannulation of the right gonadal vein can occur while inserting inferior vena cava (IVC) filter? (select one)  

A) when access is from above (e.g., jugular vein)
B) when access is from below (e.g., femoral vein)


Answer: A

The left gonadal vein drains into the left renal vein but the right gonadal vein drains directly into IVC.

Clinically this is important as inadvertent cannulation of the right gonadal vein with access from an internal jugular vein can appear similar to that of the IVC. If the operator is not aware of the slight change in the trajectory of the wire, IVC filter can get deployed in the right gonadal vein.

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References:

1. Sharma S, Mukund A, Agarwal S, Srivastava DN. Case of a misplaced IVC filter: a lesson to learn. Cardiovasc Intervent Radiol. 2010 Aug;33(4):880-2. doi: 10.1007/s00270-010-9825-y.

2. Ding PX, Han XW, Liu C, Ren KW. Inferior vena cava filter misplacement in the right ovarian vein and successful removal by loop-snare technique in a patient with inferior vena cava agenesis. J Vasc Surg Cases Innov Tech. 2018;4(4):324–326. Published 2018 Dec 10. doi:10.1016/j.jvscit.2017.12.006