1
|
Fontyn S, Bai Y, Bolger S, Greco K, Wang TF, Hamm C, Cervi A. Inferior vena cava filter use at a large community hospital: a retrospective cohort study. Sci Rep 2024; 14:10192. [PMID: 38702341 PMCID: PMC11068867 DOI: 10.1038/s41598-024-60868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Inferior vena cava (IVC) filters are considered when patients with venous thromboembolism (VTE) develop a contraindication to anticoagulation. Use of IVC filters is increasing, despite associated complications and lack of data on efficacy in reducing VTE-related mortality. We characterized the pattern of IVC filter use at a large community hospital between 2018 and 2022. Specifically, we assessed the indications for IVC filter insertion, filter removal rates, and filter-associated complications. Indications for IVC filters were compared to those outlined by current clinical practice guidelines. We reviewed 120 consecutive filter placement events. The most common indications included recent VTE and active bleeding (40.0%) or need for anticoagulation interruption for surgery (25.8%). Approximately one-third (30.0%) of IVC filters were inserted for indications either not supported or addressed by guidelines. Half (50.0%) of patients had successful removal of their IVC filter. At least 13 patients (10.8%) experienced a filter-related complication. In a large community-based practice, nearly one-third of IVC filters were inserted for indications not universally supported by current practice guidelines. Moreover, most IVC filters were not removed, raising the risk of filter-associated complications, and supporting the need for development of comprehensive guidelines addressing use of IVC filters, and post-insertion monitoring practices.
Collapse
Affiliation(s)
| | - Yuxin Bai
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Samantha Bolger
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Kaity Greco
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Caroline Hamm
- Schulich School of Medicine and Dentistry, London, ON, Canada
- Department of Medical Oncology, Windsor Regional Cancer Centre, 1995 Lens Avenue, Windsor, ON, N8W 1L9, Canada
| | - Andrea Cervi
- Schulich School of Medicine and Dentistry, London, ON, Canada.
- Department of Medical Oncology, Windsor Regional Cancer Centre, 1995 Lens Avenue, Windsor, ON, N8W 1L9, Canada.
| |
Collapse
|
2
|
Patel DM, Di Capua JF, Rouhezamin MR, Uppot RN, Kalva SP. Retrieval of a Greenfield Inferior Vena Cava Filter Indwelling for 29 Years. Vasc Endovascular Surg 2024:15385744241231134. [PMID: 38279905 DOI: 10.1177/15385744241231134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Inferior vena cava (IVC) filters are used to prevent fatal and nonfatal pulmonary embolism in patients who otherwise cannot receive anticoagulation for venous thrombosis. While generally safe and effective, complications can arise, especially after prolonged implantation. Timely retrieval is essential once the indication for insertion has resolved. However, encountering patients with long-standing embedded filters is not uncommon. This case report discusses the successful retrieval of a permanent Greenfield IVC filter after 29 years.
Collapse
Affiliation(s)
- Dipesh M Patel
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Di Capua
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Reza Rouhezamin
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raul N Uppot
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Bajda J, Park AN, Raj A, Raj R, Gorantla VR. Inferior Vena Cava Filters and Complications: A Systematic Review. Cureus 2023; 15:e40038. [PMID: 37287823 PMCID: PMC10243179 DOI: 10.7759/cureus.40038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/09/2023] Open
Abstract
Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.
Collapse
Affiliation(s)
- Joe Bajda
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Ann N Park
- Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Aishwarya Raj
- Vascular Surgery, St. George's University School of Medicine, True Blue, GRD
| | - Rhea Raj
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | | |
Collapse
|
4
|
Aun JA, Hulten EA, Nguyen BT, Twerdahl EH. Metal in motion: a case report of inferior vena cava filter migration. Eur Heart J Case Rep 2023; 7:ytad003. [PMID: 36685094 PMCID: PMC9851413 DOI: 10.1093/ehjcr/ytad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/06/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Background Inferior vena cava (IVC) filter migration, particularly to the heart, is a rare complication. Small metal fragments may be inadequately characterized on transthoracic echocardiography and may be missed entirely on chest radiograph. Managing the adverse outcomes of IVC filters is a formidable challenge as retrieval carries the risk of arrhythmia, right ventricular perforation, and damage to the tricuspid valve. Case summary A woman in her fifties underwent routine computed tomography (CT) calcium score screening and was found to have a metallic fragment in the right ventricle of her heart. Subsequent contrast enhanced, ECG-gated cardiac CTA was completed and images were reconstructed to yield cine images on syngo.via (Siemens, Erlangen, Germany) and vitrea workstation (version: 6.6.3; Vital, Toshiba Medical Systems) to guide heart team discussion and clinical management. Discussion Our case illustrates the benefit of CTA with cineography in characterizing the location, size, and extent of fragment involvement within the myocardium. Moreover, this case serves as a reminder to medical professionals to carefully consider IVC filter placement in the appropriate patient, remain vigilant regarding potential complications, and to aspire follow-up of removable filters.
Collapse
Affiliation(s)
- Jonathan A Aun
- Corresponding author. Tel: 301-295-4000, Fax: 301-295-6616, Emails: ;
| | - Edward A Hulten
- Department of Medicine, Walter Reed National Military Medical Center, Cardiology Service, 4494 Palmer Road North, Bethesda, MD 20814, USA,Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Binh T Nguyen
- Department of Radiology, Walter Reed National Military Medical Center, Cardiology Service, 4494 Palmer Road North, Bethesda, MD 20814, USA,Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | | |
Collapse
|
5
|
Classification System for Inferior Vena Cava (IVC) Appearance Following Percutaneous IVC Filter Retrieval. Cardiovasc Intervent Radiol 2022; 45:1064-1073. [PMID: 35737099 DOI: 10.1007/s00270-022-03189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE There is no classification system for describing inferior vena cava (IVC) injuries. The objective of this study was to develop a standardized grading system for venographic appearance of the IVC following percutaneous IVC filter retrieval. METHODS A classification system for the appearance of the IVC on cavograms following percutaneous IVC filter removal was developed consisting of two grading elements; luminal characteristics and extravasation. Luminal narrowing from 0% up to 50% from any cause is grade 1; narrowing between 50 and 99% is grade 2; occlusion is grade 3; and avulsion is grade 4. Absence of extravasation is grade A, contained extravasation is grade B, and free extravasation is grade C. This system was then applied retrospectively to pre- and post-IVC filter retrieval cavograms performed at a single institution from October 2004 through February 2019. RESULTS 546 retrieval attempts were identified with 509 (93.2%) filters successfully retrieved. 449 cases (88.2%) had both pre-retrieval and post-retrieval imaging appropriate for application of the proposed classification system. Inter-rater reliability was 0.972 for luminal characteristics, 0.967 for extravasation, and 0.969 overall. Consensus grading demonstrated a distribution of 97.3% grade 1, 1.3% grade 2, 1.3% grade 3, and 0.0% grade 4 for post-retrieval luminal characteristics. For extravasation classification, 96.4% of the cases were classified as grade A, 2.7% grade B, and 0.9% grade C. CONCLUSION A classification system was developed for describing IVC appearance after IVC filter retrieval, and retrospectively validated using a single center dataset.
Collapse
|
6
|
Sheehan M, Coppin K, O'Brien C, McGrath A, Given M, Keeling A, Lee MJ. A single center 9-year experience in IVC filter retrieval - the importance of an IVC filter registry. CVIR Endovasc 2022; 5:15. [PMID: 35247104 PMCID: PMC8898204 DOI: 10.1186/s42155-022-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/24/2022] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate Inferior vena cava (IVC) filter retrieval practices over a 9-year period at an academic hospital with a prospectively maintained IVC filter registry. Method An IVC filter registry was maintained prospectively within our institution. We reviewed cases between August 2011 and June 2020, following filter status, retrieval plans, and eventual retrieval date. The validity of the database was cross referenced with a Picture Archiving and Communication System and patient records. Results Three hundred forty-three patients had IVC filters inserted. Three filter types were used, Celect (Cook Medical) in 189, Gunther Tulip (GT) (Cook Medical) in 65, ALN (ALN) in 89. 196 (57%) filters were retrieved, 108 (31.5%) were made permanent, 36 (10.5%) died before retrieval, and 3 (1%) were yet to be retrieved. Retrieval rates were 92.5% overall (86% for GT, 93% for Celect and 94.5% for ALN). The mean dwell time for successful retrieval was 59 days with the majority of insertions (85%) removed in under 100 days. Failed initial retrieval occurred in 23 patients, 10 (43%) were retrieved at second attempt, 13/23 filters remained in-situ and were deemed permanent. Conclusion The removal of IVC filters, when indication for insertion has past, is no longer the sole responsibility of the referring physician but also the responsibility of the Interventionalist. Our retrieval rates of 92.5% of eligible IVC filters highlights the value of maintaining a prospective IVC filter registry.
Collapse
Affiliation(s)
- Mark Sheehan
- Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Radiology, Beaumont Hospital, Dublin, Ireland.
| | - Kristopher Coppin
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Cormac O'Brien
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Andrew McGrath
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Aoife Keeling
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Michael J Lee
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Merritt T, Powell C, Hansmann J. Safety and Effectiveness of Advanced Retrieval Techniques for Inferior Vena Cava Filters Compared to Standard Retrieval Techniques: A Systematic Review of the Literature and Meta-Analysis. J Vasc Interv Radiol 2022; 33:564-571.e4. [DOI: 10.1016/j.jvir.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022] Open
|
8
|
Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism. J Clin Med 2021; 11:jcm11010077. [PMID: 35011826 PMCID: PMC8745208 DOI: 10.3390/jcm11010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). Methods: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. Results: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. Conclusion: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines.
Collapse
|
9
|
Lee J, Roche-Nagle G. Permanent IVC filter strut penetration into an abdominal aortic aneurysm. BMJ Case Rep 2021; 14:14/6/e241962. [PMID: 34099449 DOI: 10.1136/bcr-2021-241962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 85-year-old man with a known history of abdominal aortic aneurysm (AAA) presented to a vascular surgery clinic with a severely swollen, tender and erythematous left leg. An urgent CT angiogram demonstrated a left-sided, proximal deep vein thrombosis, and a permanent, Bird's Nest inferior vena cava (IVC) filter (Cook, Inc., Bloomington, Ind.) penetrating his AAA. The patient was treated with a course of apixaban 5 mg two times per day and the decision was made to closely observe his IVC filter and AAA, given his numerous comorbidities and age. This case highlights the unique considerations associated with an approach to permanent IVC filter complications among patients with AAAs.
Collapse
Affiliation(s)
- Juehea Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|