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Abstract
The risk of venous thromboembolism (VTE) is increased in pregnancy and puerperium. Thrombophilia has been identified in pregnancy-related VTE. Venous ultrasound and ventilation-perfusion lung scanning are the initial tests; pulmonary angiography should be performed if necessary for the definitive diagnosis. Anticoagulation is achieved with heparin antepartum and warfarin postpartum. Low molecular weight heparin has been effective and safe in pregnancy. Thrombolytic therapy has been administered to pregnant patients.
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Affiliation(s)
- Dr Janet M. Shapiro
- Pulmonary/Critical Care Division, St. Luke's-Roosevelt Hospital, New York, NY
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2
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Abstract
Venous thromboembolism (VTE) is a common complication among patients in the intensive care unit. While anticoagulation remains standard therapy, vena caval filters are an important alternative when anticoagulation is contraindicated. To determine the safety and efficacy of vena caval filters in the treatment of VTE, a comprehensive review of the English-language medical literature was performed. Except for one randomized controlled trial, the literature supporting the use of vena caval filters consists almost exclusively of case series, which in many instances are limited by incomplete and short follow-up. While case series suggest that filters function effectively in the prevention of pulmonary embolism (2%-4% symptomatic pulmonary embolism [PE], fatal PE < 2%), recent higher quality studies indicate that filters may not provide significant additional protection to that provided by anticoagulation alone. Furthermore, filters are associated with a 2- fold increase in the incidence of recurrent DVT. Until randomized comparative studies are available, the safety and efficacy of all the available devices should be considered to be roughly equivalent. Since filters do not inhibit continued clot formation, all filter patients should receive anticoagulation for durations appropriate for their thrombotic disorder. Although extended anticoagulation may prevent thrombotic complications associated with filter placement, this strategy has yet to be experimentally tested. While many additional indications for vena caval filter use have been proposed (VTE in cancer patients, PE prophylaxis in trauma patients, etc), well-designed clinical trials demonstrating their efficacy in these situations are lacking. Further development of temporary/retrievable filters, which offer the potential to avoid the long-term complications of permanent filters, should be a research priority. Until additional data are available, vena caval filters should generally be restricted to patients with VTE who cannot receive anticoagulation.
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Affiliation(s)
- Michael B Streiff
- Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Ross Research Building, Room 1025, 720 Rutland Avenue, Baltimore, MD 21205, USA
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3
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Abstract
Venous thromboembolism occurs approximately in 1 of 1000 pregnancies. It is one of the leading causes of maternal mortality. Physiologic changes associated with pregnancy and delivery favor for developing venous thromboembolism, and there are individual risk factors, too, contributing to its manifestation. The most frequent risk factors of venous thromboembolism developing during pregnancy are the previous venous thromboembolism and the thrombophilias, furthermore, some other diseases and some unique complications of pregnancy and delivery. Beyond mechanical prevention only heparin preparations can be used for preventing and treating venous thromboembolism in pregnancy and among them the low-molecular-weight heparins are preferred for applying. Dosage of low-molecular-weight heparin preparations is determined by the type and strength of thrombophilia. For treatment of venous thromboembolism presented during pregnancy subcutaneous 100 IU/kg low-molecular-weight heparin is generally used at every 12 hours. Postpartum the oral anticoagulants can be safely applied, too.
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Affiliation(s)
- Attila Pajor
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Szülészeti és Nőgyógyászati Klinika Budapest Üllői út 78/A 1082.
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4
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Treatment of deep vein thrombosis—a still unresolved problem. Int J Angiol 2011. [DOI: 10.1007/bf01616508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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5
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Hill N, Hassan M, Chaudhari L, Asem AA. The use of vena cava filters in laparoscopic removal of the cervix after subtotal hysterectomy. J OBSTET GYNAECOL 2011; 31:87-8. [PMID: 21281006 DOI: 10.3109/01443615.2010.522270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Hill
- Department of Obstetrics and Gynecology, Princess Royal University Hospital, Farnborough, UK.
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6
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Given MF, McDonald BC, Brookfield P, Niggemeyer L, Kossmann T, Varma DK, Thomson KR, Lyon SM. Retrievable Gunther Tulip inferior vena cava filter: Experience in 317 patients. J Med Imaging Radiat Oncol 2008; 52:452-7. [DOI: 10.1111/j.1440-1673.2008.01969.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Nomura T, Komatsu S, Arihara M, Hayashi H, Syudo T, Harada Y, Hosomi Y, Hirano S, Matsubara H. Double-filter technique for deployment of a permanent inferior vena cava filter while avoiding the risk of pulmonary embolism from a thrombus trapped by a temporary filter. Heart Vessels 2007; 22:199-201. [PMID: 17533525 DOI: 10.1007/s00380-006-0953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/13/2006] [Indexed: 10/23/2022]
Abstract
Because temporary caval filters have not been associated with any long-term complications, their use seems practical as long as indications are accurately assessed. However, problems about further dealing with the emboli trapped in a temporary filter remain. This case report describes a new approach to managing a thrombus captured by a temporary filter during the exchange for a permanent filter. We applied the Anthéor temporary filter (Boston Scientific, Natick, MA, USA) as the device for thrombus capturing, then successfully placed the permanent filter with no clinical evidence of pulmonary embolism. Intravascular ultrasound was also useful for monitoring the entire procedure.
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Affiliation(s)
- Tetsuya Nomura
- Department of Cardiology, National Hospital Organization, Maizuru Medical Center, 2410 Yukinaga, Maizuru, Kyoto, 625-8502, Japan.
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8
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Giannoudis PV, Pountos I, Pape HC, Patel JV. Safety and efficacy of vena cava filters in trauma patients. Injury 2007; 38:7-18. [PMID: 17070525 DOI: 10.1016/j.injury.2006.08.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 08/16/2006] [Accepted: 08/17/2006] [Indexed: 02/02/2023]
Abstract
Pulmonary embolism (PE), due to its sudden onset, notoriously difficult diagnosis, unpredictable nature and often fatal outcome, remains one of the most feared complications in surgical practice. Trauma patients with multisystem injuries, extremity or pelvic fractures and head or spinal cord injuries often pose a significant dilemma for the surgeon because of the inability to use conventional measures such as anticoagulation therapy and compression devices. On the other hand, the incidence of deep vein thrombosis (DVT) is high among trauma patients and the attendant risk of PE is an important cause of morbidity and mortality. Inferior vena cava (IVC) interruption by placement of diverse filtering devices has evolved over the past three decades. With the use of these devices, the risk of PE has been reduced dramatically. However, variable rates of complications are reported from their use. In this study, we review all the available data on IVC filter placement in trauma patients and we discuss the potential complications of IVC filters in order to understand better the risk/benefit ratio of their use.
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Affiliation(s)
- Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
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9
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Looby S, Given MF, Geoghegan T, McErlean A, Lee MJ. Gunther Tulip Retrievable Inferior Vena Caval Filters: Indications, Efficacy, Retrieval, and Complications. Cardiovasc Intervent Radiol 2006; 30:59-65. [PMID: 17122885 DOI: 10.1007/s00270-006-0093-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the Gunther Tulip (GT) retrievable inferior vena cava (IVC) filter with regard to indications, filtration efficacy, complications, retrieval window, and use of anticoagulation. METHOD A retrospective study was performed of 147 patients (64 men, 83 women; mean age 58.8 years) who underwent retrievable GT filter insertion between 2001 and 2005. The indications for placement included a diagnosis of pulmonary embolism or deep venous thrombosis with a contraindication to anticoagulation (n = 68), pulmonary embolism or deep venous thrombosis while on anticoagulation (n = 49), prophylactic filter placement for high-risk surgical patients with a past history of pulmonary embolism or deep venous thrombosis (n = 20), and a high risk of pulmonary embolism or deep venous thrombosis (n = 10). Forty-nine of the 147 patients did not receive anticoagulation (33.7%) while 96 of 147 patients did, 82 of these receiving warfarin (56.5%), 11 receiving low-molecular weight heparins (7.58%), and 3 receiving antiplatelet agents alone (2.06%). RESULTS Filter placement was successful in 147 patients (100%). Two patients had two filters inserted. Of the 147 patients, filter deployment was on a permanent basis in 102 and with an intention to retrieve in 45 patients. There were 36 (80%) successful retrievals and 9 (20%) failed retrievals. The mean time to retrieval was 33.6 days. The reasons for failed retrieval included filter struts tightly adherent to the IVC wall (5/9), extreme filter tilt (2/9), and extensive filter thrombus (2/9). Complications included pneumothorax (n = 4), failure of filter expansion (n = 1), and breakthrough pulmonary embolism (n = 1). No IVC thrombotic episodes were recorded. DISCUSSION The Gunther Tulip retrievable filter can be used as a permanent or a retrievable filter. It is safe and efficacious. GT filters can be safely retrieved at a mean time interval of 33.6 days. The newly developed Celect filter may extend the retrieval interval.
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Affiliation(s)
- S Looby
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
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10
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Kaskarelis IS, Koukoulaki M, Chlapoutaki CE, Skarpalezos DE, Baltouka AD, Vagdatlis TK, Androutsopoulou VA, Bellenis I. Clinical experience with Günther temporary inferior vena cava filters. Clin Imaging 2006; 30:108-13. [PMID: 16500541 DOI: 10.1016/j.clinimag.2005.09.024] [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] [Received: 08/10/2005] [Revised: 09/07/2005] [Accepted: 09/07/2005] [Indexed: 11/21/2022]
Abstract
This retrospective study was performed to evaluate the safety and effectiveness of Günther temporary inferior vena cava (IVC) filters. Fifteen Günther temporary filters were placed in 13 patients because of deep vein thrombosis (DVT) with pulmonary embolism (PE) despite DVT prophylaxis (9/13) or temporary contraindications for anticoagulants as well as recent or pending surgery (4/13). No clinical manifestation of PE was observed during the filtration or during the removal. Günther temporary IVC filters are easy and safe to use, and are effective in clot trapping, protecting patients at high risk for PE in whom anticoagulation treatment failed or is contraindicated.
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Affiliation(s)
- Ioannis S Kaskarelis
- "Evangelismos" General Hospital of Athens, 45-47 Ipsilantou Street, 10676 Athens, Greece
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11
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Sarani B, Chun A, Venbrux A. Role of Optional (Retrievable) IVC Filters in Surgical Patients at Risk for Venous Thromboembolic Disease. J Am Coll Surg 2005; 201:957-64. [PMID: 16310701 DOI: 10.1016/j.jamcollsurg.2005.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 07/25/2005] [Accepted: 07/26/2005] [Indexed: 11/15/2022]
Affiliation(s)
- Babak Sarani
- Department of Surgery, The George Washington University, Washington, DC, USA
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12
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Oliva VL, Szatmari F, Giroux MF, Flemming BK, Cohen SA, Soulez G. The Jonas Study: Evaluation of the Retrievability of the Cordis OptEase Inferior Vena Cava Filter. J Vasc Interv Radiol 2005; 16:1439-45; quiz 1445. [PMID: 16319149 DOI: 10.1097/01.rvi.0000171699.57957.c7] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the success, safety, and efficacy of the retrieval of the OptEase Permanent/Retrievable Vena Cava Filter (Cordis, Warren, NJ), when implanted for temporary protection against venous thromboembolism. MATERIALS AND METHODS This prospective, multicenter, non-randomized study enrolled 27 patients who needed temporary protection against pulmonary embolism in whom the intent at the time of filter insertion was retrieval of the OptEase filter. Patients presented with deep venous thrombosis (n = 17), pulmonary embolism (PE) (n = 6), and high risk for PE without thromboembolic disease (n = 4). Assessments included duplex sonography of the access site performed within 24 hours of device implantation and retrieval. All patients underwent cavography before and after filter placement and filter retrieval. Contrast-enhanced computed tomography (CT) of the abdomen and clinical follow-up was performed at 1 month after device retrieval. RESULTS Of the 27 enrolled patients, 21 patients (77.8%) met the criteria for retrieval and all 21 patients (100%) had filters successfully retrieved with no associated adverse events. Retrieval was not attempted in six patients as a result of ongoing contraindication to anticoagulation (n = 3), large trapped thrombi within the filter (n = 2), and poor patient prognosis (n = 1). Time to retrieval ranged from 5 to 14 days with a mean implantation time of 11.1 days +/- 1.82. No symptomatic pulmonary embolism, vena cava wall injury, vena cava stenosis, significant bleeding, filter fracture, or filter migration was observed. Nineteen of the 21 patients (90.5%) were followed for 1-month post-retrieval with no device-related adverse events or symptomatic PE. Caval patency was documented in 18 of these 19 patients with CT. Two patients were lost to follow-up, and one patient refused to undergo CT examination. CONCLUSION The OptEase permanent/retrievable vena cava filter can be safely and successfully retrieved up to 14 days in patients who no longer require inferior vena cava filter protection against pulmonary embolism.
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Affiliation(s)
- Vincent L Oliva
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
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13
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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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14
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Büller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126:401S-428S. [PMID: 15383479 DOI: 10.1378/chest.126.3_suppl.401s] [Citation(s) in RCA: 1002] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This chapter about antithrombotic therapy for venous thromboembolic disease is part of the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: for patients with objectively confirmed deep vein thrombosis (DVT), we recommend short-term treatment with subcutaneous (SC) low molecular weight heparin (LMWH) or, alternatively, IV unfractionated heparin (UFH) [both Grade 1A]. For patients with a high clinical suspicion of DVT, we recommend treatment with anticoagulants while awaiting the outcome of diagnostic tests (Grade 1C+). In acute DVT, we recommend initial treatment with LMWH or UFH for at least 5 days (Grade 1C), initiation of vitamin K antagonist (VKA) together with LMWH or UFH on the first treatment day, and discontinuation of heparin when the international normalized ratio (INR) is stable and > 2.0 (Grade 1A). For the duration and intensity of treatment for acute DVT of the leg, the recommendations include the following: for patients with a first episode of DVT secondary to a transient (reversible) risk factor, we recommend long-term treatment with a VKA for 3 months over treatment for shorter periods (Grade 1A). For patients with a first episode of idiopathic DVT, we recommend treatment with a VKA for at least 6 to 12 months (Grade 1A). We recommend that the dose of VKA be adjusted to maintain a target INR of 2.5 (INR range, 2.0 to 3.0) for all treatment durations (Grade 1A). We recommend against high-intensity VKA therapy (INR range, 3.1 to 4.0) [Grade 1A] and against low-intensity therapy (INR range, 1.5 to 1.9) compared to INR range of 2.0 to 3.0 (Grade 1A). For the prevention of the postthrombotic syndrome, we recommend the use of an elastic compression stocking (Grade 1A). For patients with objectively confirmed nonmassive PE, we recommend acute treatment with SC LMWH or, alternatively, IV UFH (both Grade 1A). For most patients with pulmonary embolism (PE), we recommend clinicians not use systemic thrombolytic therapy (Grade 1A). For the duration and intensity of treatment for PE, the recommendations are similar to those for DVT.
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Affiliation(s)
- Harry R Büller
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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15
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Stein PD, Alnas M, Skaf E, Kayali F, Siddiqui T, Olson RE, Patel K. Outcome and complications of retrievable inferior vena cava filters. Am J Cardiol 2004; 94:1090-3. [PMID: 15476636 DOI: 10.1016/j.amjcard.2004.06.077] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Revised: 06/25/2004] [Accepted: 06/25/2004] [Indexed: 11/25/2022]
Abstract
The results and risks of retrievable inferior vena cava filters were reviewed. Systematic review identified 6 prospective case series with broad ranges of indications for filters. In these case series, 4 different types of retrievable filters were inserted in 284 patients. The longest reported duration of insertion was 134 days. Among patients in whom percutaneous removal of the filter was attempted, the filter was successfully removed in 144 of 159 (91%). Surgery was necessary to remove the filter from 1 patient (1%), and filters could not be removed because of large trapped thrombi in 14 patients (9%).
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Affiliation(s)
- Paul D Stein
- St. Joseph Mercy Oakland Hospital, Pontiac, Michigan 48341-3244, USA.
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16
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Wicky S, Doenz F, Meuwly JY, Portier F, Schnyder P, Denys A. Clinical experience with retrievable Günther Tulip vena cava filters. J Endovasc Ther 2004; 10:994-1000. [PMID: 14656169 DOI: 10.1177/152660280301000524] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report clinical experience with retrievable Günther Tulip filters from implantation to retrieval and their status in nonretrieved situations. METHODS Seventy-five Günther Tulip filter implantations were performed in 71 patients (43 women; mean age 55 years). Indications for filter placement were pulmonary embolism (PE) or iliofemoral deep vein thrombosis (DVT) in patients with a contraindication to anticoagulation (43, 61%) or perioperative PE prophylaxis (28, 39%) in patients with confirmed iliofemoral DVT. Retrieval procedures were planned for each patient. Patients with nonretrieved filters were followed with plain radiography and duplex sonography. RESULTS Technical success of filter insertion was 97.3% (73/75). Eighteen (25%) patients died from unrelated causes prior to retrieval attempts, and 6 other patients were too critically ill for a retrieval procedure. Of 49 (67%) planned retrieval attempts, 14 (19%) filters could not be removed owing to large trapped thrombi. The mean implantation period for the 35 (48%) retrieved filters was 8.2 days (range 1-13). Delivery tilt was observed in 12 (16%) filters and during retrieval attempts in 1 more case. For 9 nonretrieved filters, tilt and migration were observed in 22% at a mean follow-up of 30 months, but no venous thrombosis was assessed. CONCLUSIONS Our data confirm the clinical efficacy of the Günther Tulip filter during implantation and the feasibility of its retrieval. Further long-term follow-up should be conducted on nonretrieved filters to confirm our results.
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Affiliation(s)
- Stephan Wicky
- Department of Radiology, University Hospital, Lausanne, Switzerland.
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17
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Tay KH, Martin ML, Fry PD, Webb JG, Machan LS. Repeated Günther Tulip inferior vena cava filter repositioning to prolong implantation time. J Vasc Interv Radiol 2002; 13:509-12. [PMID: 11997359 DOI: 10.1016/s1051-0443(07)61531-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A patient presented with iliofemoral deep vein thrombosis, a small pulmonary embolism, and a paradoxic embolus to the axillary artery resulting from a patent foramen ovale (PFO). As prophylaxis against further paradoxic emboli while awaiting percutaneous PFO closure, a Günther Tulip inferior vena cava (IVC) filter was implanted. To prevent incorporation of the IVC filter into the caval wall, it was repositioned twice with use of a filter retrieval set from a transjugular approach. In this way, the implantation time of the filter was extended beyond the recommended period of 10 days. The filter was successfully retrieved 19 days later during percutaneous closure of the PFO.
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Affiliation(s)
- Kiang-Hiong Tay
- Department of Radiology, University of British Columbia Hospitals, Campus Site, 2211 Wesbrook Mall, Vancouver, V6T 2B5 British Columbia, Canada
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18
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Affiliation(s)
- F B Rogers
- Department of Surgery, Fletcher Allen Health Care, Burlington, VT 05401, USA
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Kanda Y, Yamamoto R, Chizuka A, Suguro M, Hamaki T, Matsuyama T, Takezako N, Miwa A, Togawa A, Kume M, Tsukuda M, Hasuo K. Treatment of deep vein thrombosis using temporary vena caval filters after allogeneic bone marrow transplantation. Leuk Lymphoma 2000; 38:429-33. [PMID: 10830752 DOI: 10.3109/10428190009087036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bone marrow transplant (BMT) recipients have risk factors for deep vein thrombosis (DVT) including venous stasis caused by immobilization in the sterile unit, vessel wall damage caused by preparative regimen or indwelling catheters, and hypercoagulability caused by decreased natural anticoagulants. We successfully treated a patient who developed massive DVT in the superior vena cava after BMT with anticoagulation and the use of temporary vena caval filters. Considering the delayed complications, permanent filter is not appropriate for BMT recipients, because the risk factors for DVT associated with BMT are transient. We considered that temporary vena caval filter is a safe and useful device to prevent pulmonary embolism after DVT in BMT recipients.
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Affiliation(s)
- Y Kanda
- Department of Hematology, International Medical Center of Japan, Tokyo.
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21
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Millward SF, Bhargava A, Aquino J, Peterson RA, Veinot JP, Bormanis J, Wells PS. Günther Tulip filter: preliminary clinical experience with retrieval. J Vasc Interv Radiol 2000; 11:75-82. [PMID: 10693717 DOI: 10.1016/s1051-0443(07)61286-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The Günther Tulip filter is a permanent filter that has a hook to permit retrieval. The authors report their preliminary clinical evaluation of the filter with regard to feasibility and safety of retrieval. MATERIALS AND METHODS Nine men and six women who ranged in age from 17 to 79 years (mean, 51 years) underwent treatment with use of the Günther Tulip filter. Patients judged to require caval interruption for < 14 days were selected to receive the filter and retrieval was planned for all patients. Indications for filter placement were: recent pulmonary embolism (PE) or proximal deep vein thrombosis (DVT) with a contraindication to anticoagulation (11 patients), massive PE treated with thrombolytic therapy (one patient), PE with heparin-induced thrombocytopenia (one patient), and prophylaxis after major trauma (two patients). Patients were followed for inferior vena cava (IVC) thrombosis, bleeding, and recurrent DVT or PE. RESULTS In all nine patients in whom it was attempted, the filter was successfully snared and retrieved via a jugular approach. The mean implantation period was 8.6 days (range, 5-13 days). Retrieval required 2.2-13 minutes (mean 5.3 minutes) of fluoroscopy. No caval injuries occurred as a result of retrieval. All retrieved filters had strands of organized thrombus on the filter struts. The patients were followed for 52-285 days (mean, 115 days) after retrieval. One patient developed a recurrent DVT 230 days after retrieval. No other patients developed a recurrent DVT and no patients developed IVC thrombosis, bleeding, or PE. Six filters were not retrieved: five because of an ongoing contraindication to anticoagulation and one because the patient died of causes unrelated to the filter. CONCLUSION This preliminary study confirms the feasibility and safety of retrieval of the Günther Tulip filter up to 13 days after implantation.
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Affiliation(s)
- S F Millward
- Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ontario, Canada.
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Lorch H, Welger D, Wagner V, Hillner B, Strecker EP, Herrmann H, Voshage G, Zur C, Schwarzbach C, Schröder J, Gullotta U, Pleissner J, Huttner S, Siering U, Märcklin C, Chavan A, Gläser F, Apitzsch DE, Moubayed K, Leonhardi J, Schuchard UM, Weiss HD, Zwaan M. Current practice of temporary vena cava filter insertion: a multicenter registry. J Vasc Interv Radiol 2000; 11:83-8. [PMID: 10693718 DOI: 10.1016/s1051-0443(07)61287-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the current practice of temporary vena cava filter placement and its complications. MATERIALS AND METHODS A multicenter registry was conducted from May 1995 until May 1997 using a standardized questionnaire. One hundred eighty-eight patients were evaluated. Patient characteristics, filter indications, filter characteristics, and complications were registered. RESULTS Deep vein thrombosis was proven in 95.2% of the patients. Main filter indication was thrombolysis therapy (53.1%). Average filter time was 5.4 days. An Antheor filter was inserted in 56.4%, a Guenther filter in 26.6%, and a Prolyser filter in 17.%. Transfemoral filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during filter protection. Major filter problems were filter thrombosis (16%) and filter dislocation (4.8%). When thrombus was found in or at the filter before explantation, additional thrombolysis was performed in 16.7%, additional filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of filters were replaced with permanent filters. DISCUSSION Temporary vena cava filters are placed to prevent PE in a defined patient population. Despite their presence, PEs still occur in a small percentage. Problems of filter thrombosis and dislocation have to be solved. CONCLUSION The results of this multicenter registry support the need for innovative filter design, as well as a randomized, prospective study.
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Affiliation(s)
- H Lorch
- Department of Radiology, Medical University of Luebeck, Lübeck, Germany.
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Pavcnik D, Uchida BT, Keller FS, Corless CL, Rösch J. Retrievable IVC square stent filter: experimental study. Cardiovasc Intervent Radiol 1999; 22:239-45. [PMID: 10382057 DOI: 10.1007/s002709900374] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In vitro and in vivo evaluation of a new retrievable, home-made, inferior vena cava (IVC) Square stent filter (SSF) with two trapping levels. METHODS In vitro, the SSF was compared in a flow model with the stainless steel Greenfield filter (SGF) for emboli-trapping efficiency by serially passing 300 emboli of 3 and 6 mm in diameter and 15-30 mm in length in each type of filter. Nine swine were used for the in vivo testing of the SSF for deployment and retrievability, emboli-trapping efficiency, stability, and self-centering ability and two were used (total of 11 swine) for testing repositioning and retrievability of the SSF at 2 weeks and for gross and histologic IVC changes at 2 months. RESULTS In vitro, the SSF and SGF had similar efficiency in trapping large emboli but the SSF had significantly better efficiency than the SGF for trapping all sizes of emboli (91.7% vs 81%), medium size emboli (93% vs 80%), and small emboli (86% vs 69%). Efficiency decreased in both filters from the first to the fifth embolus in each series but was still significantly better for the SSF. With the SSF, 89% of emboli were caught at the primary and 11% at the secondary filtration level. In the nine animals used for acute studies, the SSF was easily placed in all 27 attempts, assumed a central position 26 times, and was easily retrieved in 21 of 22 attempts. One tilted filter needed additional manipulation for retrieval. During emboli injection in five swine, the SSF had 97.2% emboli-trapping efficiency and demonstrated good stability. In the two animals used for longer-term evaluation, the filters were easily retrieved 2 weeks after implantation. Histologic evaluation at 2 months showed neointimal proliferation around the SSF wires in contact with the IVC wall, which was otherwise normal. CONCLUSION The SSF is a promising filter. It is easy to place and retrieve, is stable after placement, and has high efficiency for trapping emboli. Promising results justify further experimental and eventual clinical studies with a commercially manufactured SSF.
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Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
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