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Dria SJ, Eggers MD. In vitro evaluation of clot capture efficiency of an absorbable vena cava filter. J Vasc Surg Venous Lymphat Disord 2016; 4:472-8. [PMID: 27639002 DOI: 10.1016/j.jvsv.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the in vitro clot capture efficiency (CCE) of an investigational absorbable inferior vena cava filter (IVCF) vs the Greenfield IVCF. METHODS Investigational absorbable and Greenfield filters were challenged with polyacrylamide clot surrogates ranging from 3 × 5 to 10 × 24 mm (diameter × length) in a flow loop simulating the venous system. Filters were challenged with clots until CCE standard error of 5% or less was achieved under binomial statistics. Pressure gradients across the filters were measured for the largest size clot, enabling calculation of forces on the filter. RESULTS The in vitro CCE of the absorbable IVCF was statistically similar to that of the Greenfield filter for all clot sizes apart from the 3 × 10-mm clot, for which there was statistically significant difference between filter CCEs (absorbable filter, 59%; Greenfield filter, 31%; P = .0001). CCE ranged from an average 32% for the 3 × 5-mm clot to 100% for 7 × 10-mm and larger clots for the absorbable IVCF. Pressure gradient across the absorbable filter with 10 × 24-mm clot averaged 0.14 mm Hg, corresponding to a net force on the filter of 2.1 × 10(-3) N, compared with 0.39 mm Hg or 5.8 × 10(-3) N (P < .001) for the Greenfield filter. CONCLUSIONS CCE of the absorbable filter was statistically similar to or an improvement on that of the Greenfield stainless steel filter for all clot sizes tested. CCE of the Greenfield filter in this study aligned with data from previous studies. Given the efficacy of the Greenfield filter in attenuating the risk of pulmonary embolism, the current study suggests that the absorbable filter may be a viable candidate for subsequent human testing.
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Affiliation(s)
| | - Mitchell D Eggers
- Adient Medical, Pearland, Tex; Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex; Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
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Abstract
Optional vena cava filters can used to provide either short-term or permanent protection from pulmonary embolism. These devices have recently become available for clinical use in the United States. However, there remains a paucity of data about these devices and their outcomes. This article reviews current and future devices, the rationale behind non-permanent caval filtration, and the generally accepted guidelines for their clinical application.
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Affiliation(s)
- John A. Kaufman
- *Dotter Institute/Oregon Health & Science University, Portland, OR
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Pavcnik D, Uchida BT, Timmermans H, Corless CL, Keller FS, Rösen J. Aortic and venous valve for percutaneous insertion. MINIM INVASIV THER 2010; 9:287-92. [DOI: 10.1080/13645700009169659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hoppe H, Beyer TJ, Park WK, Uchida BT, Pavcnik D, Keller FS, Kaufman JA. Optional vena cava filter with disengaging centering struts: retrieval in an animal model. J Vasc Interv Radiol 2008; 19:1772-6. [PMID: 18948023 DOI: 10.1016/j.jvir.2008.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 08/24/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022] Open
Abstract
An optional inferior vena cava (IVC) filter prototype was evaluated for safety and long-term retrievability as an initial feasibility study in an animal model. This filter has four centering struts that have the ability to disengage from the filtering cone portion, allowing the legs to slide out of endothelial growth. Retrieval of six filters in three animals was successful up to 27 weeks. There was no substantial filter tilt, migration, or IVC damage. In conclusion, this filter design may help overcome some of the shortcomings in currently approved optional IVC filters, including long-term retrieval difficulties, tilting, or migration.
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Affiliation(s)
- Hanno Hoppe
- Dotter Interventional Institute, Oregon Health & Science University, Portland, Oregon, USA
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Hoppe H, Uchida BT, Pavcnik D, Kim MD, Park WK, Correa LO, Kaufman JA, Keller FS, Rösch J. Angioscopy for experimental evaluation of optional IVC filters. J Vasc Interv Radiol 2007; 18:277-82. [PMID: 17327562 DOI: 10.1016/j.jvir.2006.12.715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of direct angioscopic visualization of an optional inferior vena cava (IVC) filter in situ and during retrieval. MATERIALS AND METHODS Angioscopy was used for direct visualization of optional IVC filters in six sheep. Cavograms were obtained before the filters were retrieved. After successful filter retrieval, segmental IVC perfusion was performed to evaluate filter retrieval-related damage to the IVC wall. Therefore, all branch vessels were ligated before the IVC segment was flushed with normal saline solution until it was fully distended. Then, the inflow was terminated and the IVC segment observed for deflation. Subsequently, the IVC was harvested en bloc, dissected, and inspected macroscopically. RESULTS The visibility of IVC filters at angioscopy was excellent. During the retrieval procedure, filter collapse and retraction into the sheath were clearly demonstrated. Angioscopy provided additional information to that obtained with cavography, demonstrating adherent material in three filters. Three filters in place for more than 2 months could not be retrieved because the filter legs were incorporated into the IVC wall. After filter retrieval, there was no perforation at segmental IVC perfusion. At macroscopic inspection of the IVC lumen, a small piece of detached endothelium was found in one animal. CONCLUSION Angioscopy enabled the direct evaluation of optional IVC filters in situ and during retrieval. Compared with cavography, angioscopy provided additional information about the filter in situ and the retrieval procedure. Future applications of this technique could include studies of filter migration, compression, and clot-trapping efficacy.
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Affiliation(s)
- Hanno Hoppe
- Dotter Interventional Institute, Oregon Health & Sciences University, L-342, 3181 SW Sam Jackson Park Rd, Portland, OR 7239-3098, USA.
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Guidelines for the Use of Retrievable and Convertible Vena Cava Filters: Report from the Society of Interventional Radiology Multidisciplinary Consensus Conference. World J Surg 2007. [DOI: 10.1007/s00268-006-0292-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kaufman JA, Kinney TB, Streiff MB, Sing RF, Proctor MC, Becker D, Cipolle M, Comerota AJ, Millward SF, Rogers FB, Sacks D, Venbrux AC. Guidelines for the Use of Retrievable and Convertible Vena Cava Filters: Report from the Society of Interventional Radiology Multidisciplinary Consensus Conference. J Vasc Interv Radiol 2006; 17:449-59. [PMID: 16567669 DOI: 10.1097/01.rvi.0000203418-39769.0d] [Citation(s) in RCA: 270] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- John A Kaufman
- Dotter Interventional Institute, Oregon Health & Science University, Portland, 97239, USA.
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Hamada A, Goktay AY, Pavcnik D, Kaufman JA, Uchida BT, Timmermans HA, Correa LO, Keller FS, Rösch J. Long-term optional retrievability of a new inferior vena cava filter in an ovine model. J Vasc Interv Radiol 2005; 16:1505-9. [PMID: 16319158 DOI: 10.1097/01.rvi.0000180364.35781.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Long-term retrievability of a new optional retrieval inferior vena cava (IVC) filter composed of a modified square stent and a modified Günther Tulip filter was tested in eight sheep. Eleven filters were placed into the IVC and eight were successfully retrieved 3-5 months after implantation. Incorporation of the filter struts into the IVC wall prevented its retrieval in three sheep at 3, 4, and 5 months after placement.
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Affiliation(s)
- Ayumi Hamada
- Department of Radiology, Mie University School of Medicine, Japan
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Braile DM, Godoy JMPD, Centola M. Avaliação in vitro de um novo filtro de veia cava. J Vasc Bras 2005. [DOI: 10.1590/s1677-54492005000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O objetivo do estudo foi avaliar a eficácia de um novo filtro de veia cava, de baixo perfil, na retenção de coágulos em modelo in vitro. MÉTODO: O filtro consiste em dois cones opostos pelo ápice. O cone distal é formado por oito hastes de aço inoxidável, que têm a função de retenção dos êmbolos. O cone proximal é constituído de quatro hastes, cuja função é ancorar e centralizar. Os filtros foram introduzidos e fixados no interior de um tubo de PVC transparente de 25, 30 e 35 mm de diâmetro interno, em posição vertical, e conectados com um sistema pulsátil de fluxo (bomba peristáltica). Foi utilizado, para veículo, um reservatório com solução salina (0,9%) com 40% de glicerina, mantido em temperatura ambiente. Confeccionaram-se trombos com sangue bovino em tubos plásticos de 3, 4,5 e 6 mm de diâmetro e, posteriormente, foram segmentados nas medidas de 10, 15, 20 e 30 mm de comprimento, totalizando 12 diferentes tamanhos. Realizaram-se 100 liberações para cada tipo de êmbolo e tamanho das cânulas, totalizando 3.600 eventos. Foram feitos lançamentos seqüenciais com cinco êmbolos, sendo 10 para cada tamanho de êmbolo e cânulas, totalizando 360 eventos. Fez-se avaliação da capacidade de retenção dinâmica utilizando os três diferentes tamanhos de cânulas com 100 eventos cada, totalizando 300 eventos. RESULTADOS: Detectou-se que o diâmetro e comprimento dos êmbolos, assim como diâmetros da cânula, podem comprometer a eficácia do filtro. A média de captura de êmbolos pelos filtros foi de 80,5% nas cânulas de 35 mm, 88,7% para cânulas de 30 mm e 86,6% para cânulas de 25 mm. CONCLUSÃO: Conclui-se que a eficácia desse filtro sofre interferência relacionada ao tamanho dos êmbolos e diâmetro da cânula.
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Terhaar OA, Lyon SM, Given MF, Foster AE, Mc Grath F, Lee MJ. Extended Interval for Retrieval of Günther Tulip Filters. J Vasc Interv Radiol 2004; 15:1257-62. [PMID: 15525745 DOI: 10.1097/01.rvi.0000134497.50590.e2] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the Gunther Tulip vena cava filter with regard to ease of placement, complications, and retrieval over long time periods. MATERIALS AND METHODS In 53 patients (ratio of men to women, 24:29; mean age, 52.8 years) retrievable Gunther Tulip filters (Vena Cava M Reye Filter Set; William Cook Europe, Denmark) were inserted. Indications included planned major surgery with recent pulmonary embolus or high pulmonary embolus risk (n = 16), extensive ilio-femoral thrombus (n = 11), deep vein thrombosis with anticoagulant complications (n = 9), breakthrough pulmonary embolus despite anticoagulant therapy (n = 4), and contraindication to anticoagulant therapy (n = 13). All patients were followed-up for immediate and long-term complications. RESULTS Fifty-three filters were successfully placed in 52 of 53 patients, yielding a success rate of 98.1%. Nineteen patients underwent attempted retrieval of their filter. Sixteen of 19 retrieval procedures were successful (84%). In three patients, the filter could not be removed on attempted retrieval (extensive filter thrombus in two patients and attachment to the wall in one patient). One patient received two filters, which were both successfully retrieved at a later date. Median implantation time for retrievable filters was 34 days (range, 7-126 days). Mean follow-up for patients with permanent filters was 13 months. Two major complications (pneumothorax and break through pulmonary embolus) and three minor complications (right internal jugular vein thrombosis in two patients and transient Horner's Syndrome in one patient) were recorded. CONCLUSION Insertion and retrieval of filters is safe and feasible. Preliminary data suggest that Gunther Tulip filter retrieval is feasible over and above the manufacturer's recommended retrieval interval of 14 days.
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Affiliation(s)
- Olaf Alfons Terhaar
- Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin 9, Ireland
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Affiliation(s)
- John A Kaufman
- Dotter Interventional Institute/OHSU, L-605, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Reekers JA, Hoogeveen YL, Wijnands M, Bosma G, Mulder R, Oliva VL. Evaluation of the Retrievability of the OptEase IVC Filter in an Animal Model. J Vasc Interv Radiol 2004; 15:261-7. [PMID: 15028811 DOI: 10.1097/01.rvi.0000116186.30591.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE A new inferior vena cava filter was evaluated in vivo to determine the percutaneous retrievability after an implantation period of up to 18 days. MATERIALS AND METHODS The inferior venae cavae of six goats were percutaneously implanted with three filters, and one animal received two filters. To assess filter stability, a plain radiograph was obtained after 7-9 days and on the day of retrieval. After cavography, filter retrieval with an endovascular snare and retrieval catheter was performed in three animals after 12 days and in three others after 14 days. In one animal, retrieval of one filter was performed after 18 days, and one filter was intended to be permanent. Twenty-eight days after filter retrieval, cavography was performed before inferior vena cava removal for gross and histologic examination. RESULTS All filters (N = 20) were implanted without complications. There was no migration during the implantation period. Preretrieval cavography demonstrated all filters to be patent and centered. Filters intended for retrieval (n = 19) were all successfully extracted at 12 (nine filters), 14 (nine filters), and 18 days (one filter). For the animal with the filter extracted at 18 days, one filter remained in situ intentionally. Postretrieval cavography showed no visible signs of vessel wall anomalies. There were no complications during the 28 days of follow-up after retrieval. Presacrifice cavography showed no evidence of caval wall abnormalities. In all animals, gross examination of the inner wall of the explanted vena cava showed only minimal macroscopic changes. The struts of the filter in situ for 46 days (18 days with 28 days of follow-up) were overgrown with neointima. Histological study of the 19 filter retrieval sites revealed no to moderate intima proliferation, minimal residual signs of hemorrhages, and no or only occasional slight inflammatory reaction. CONCLUSIONS In this animal model, the new vena cava filter demonstrated event-free retrieval, without postretrieval complications, up to 18 days postimplantation. After implantation of 46 days, the filter showed neointima overgrowth of the struts.
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Affiliation(s)
- Jim A Reekers
- Department of Radiology, Amsterdam Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Brountzos EN, Kaufman JA, Venbrux AC, Brown PR, Harry J, Kinst TF, Kleshinski S, Ravenscroft AC. A new optional vena cava filter: retrieval at 12 weeks in an animal model. J Vasc Interv Radiol 2003; 14:763-72. [PMID: 12817044 DOI: 10.1097/01.rvi.0000079986.80153.cc] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To test the feasibility and safety of percutaneous retrieval of a new inferior vena cava (IVC) filter, the Recovery Filter (RF), acutely and after 12-week implantation in sheep. MATERIALS AND METHODS The RF is a bilevel filter with stabilizing arms and elastic hooks that allow retrieval with a unique retrieval cone after incorporation into the wall of the IVC. Twenty-four filters were placed in the infrarenal IVCs of 18 sheep. In six sheep, two filters were placed and then removed immediately; three sheep were killed acutely and three were killed after a healing period of 3 weeks. In 12 sheep, a single filter was placed and then removed 12 weeks later; six were killed after retrieval and six were killed after an 8-week healing period. RESULTS The mean (+/-SD) transverse vena caval diameter was 15.3 mm +/- 2. All filters were deployed as intended and retrieved without difficulty. At sacrifice, there was no evidence of IVC perforation or retroperitoneal abnormality. The IVCs of the animals in the acute retrieval group showed minimal acute superficial injury that was largely reversed at 3 weeks. At 12 weeks, there was evidence of transmural incorporation of filter elements with narrowing of the IVCs. Solitary fibrotic abnormalities were present in the aorta adjacent to IVC lesions in nine of the 12 animals in the 12-week group. The IVC and aortic abnormalities were largely healed, with reversal of IVC narrowing after 8 weeks. CONCLUSION The recovery filter can be reliably and safely retrieved acutely and 12 weeks after implantation in sheep.
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Affiliation(s)
- Elias N Brountzos
- Second Department of Radiology, Medical School, University of Athens, Greece
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Wallace MJ, Ahrar K, Wright KC. Validation of US-guided percutaneous venous access and manual compression for studies in swine. J Vasc Interv Radiol 2003; 14:481-3. [PMID: 12682205 DOI: 10.1097/01.rvi.0000064844.87207.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To validate, in swine, the feasibility, efficacy, and safety of ultrasound (US)-guided vascular access, with manual compression for hemostasis, as an alternative to surgical cutdown. MATERIALS AND METHODS US-guided femoral vein access was attempted 22 times in eight pigs. Bilateral access was performed in the initial procedure (eight pigs, 16 veins), and unilateral access was performed during follow-up procedures (six pigs, six veins). Two sheath sizes were used: 9 F (in eight veins) and 8 F (in 14 veins). At the completion of each procedure, the vascular sheaths were removed and hemostasis was attempted by manual compression. All animals were followed clinically for at least 24 hours after each access procedure. Bilateral US images of the femoral region were obtained in six pigs (12 puncture sites) 2 weeks after the initial procedure. RESULTS US-guided femoral vein access was successful in all 22 attempts, including 16 first-time insertions and six subsequent insertions. Hemostasis was achieved with 5 minutes of manual compression in all 22 procedures. No groin complications were identified on clinical follow-up or at necropsy. US imaging of the 12 femoral access points in the six pigs that underwent more than one procedure demonstrated normal femoral veins that compressed appropriately with no evidence of thrombosis or hematoma. CONCLUSION US-guided femoral vein access, with manual compression used for hemostasis, is a safe and effective method for venous interventions in swine. Moreover, this percutaneous technique allows the same vessel to be reused.
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Affiliation(s)
- Michael J Wallace
- John S. Dunn Center for Radiological Sciences, Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, the University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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