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1) Failure of the left caudal supracardinal vein to regress results in persistent communication between the left common iliac vein and the left renal vein.
We were successful in retracting the bullet from the IVC into the common iliac vein and subsequently into the common femoral vein with a basket.
Table 1 Course of bullet Date Position of bullet Identification 12/3/00 Right costophrenic recess Chest x-ray 12/7/00 Right groin Fluoroscopy 12/7/00 Left common iliac vein Computed tomography 12/7/00 Upper inferior vena cava Review of admission CT 12/7/00 Left common iliac vein Vascular intervention (unsuccessful) 12/8/00 Right costophrenic recess Chest x-ray 12/8/00 Bullet retrieved Vascular intervention through right common femoral vein
This bullet changed positions and moved freely within the IVC and the common iliac veins.
There was also a thrombus extending from the catheter to the proximal ends of both common iliac veins.
There was poor contrast filling in both common iliac veins, suggesting distal extension of tumour thrombus to the confluence of the common iliac veins.