1
|
Duszak R, Parker L, Levin DC, Rao VM. Placement and Removal of Inferior Vena Cava Filters: National Trends in the Medicare Population. J Am Coll Radiol 2011; 8:483-9. [DOI: 10.1016/j.jacr.2010.12.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
|
2
|
Chinsakchai K, Ten Duis K, Moll FL, de Borst GJ. Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg 2011; 45:5-14. [PMID: 21193462 DOI: 10.1177/1538574410388309] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Phlegmasia cerulea dolens (PCD) is a fulminant condition of acute massive venous thrombosis that may result in major amputation or death unless treated in an early phase. Guidelines for treatment are still not clearly documented. As a consequence, physicians might have limited knowledge of this potential life-threatening condition and its clinical course. Therefore, the purpose of this review was to analyze and summarize clinical manifestations and proposed diagnostic approach, factors that affect the outcome of PCD, and the evolution of management and therapeutic options. Underlying malignancy, pulmonary embolism, and PCD severity are the vital factors that predict the outcome of PCD. In the last decades, treatment options have remained largely unchanged. Published evidence shows that advances in minimally invasive techniques have not yet resulted in outcome improvements compared with traditional surgical thrombectomy. Treatment seems to depend on grading the severity of this condition and experience of the surgeon.
Collapse
Affiliation(s)
- Khamin Chinsakchai
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | |
Collapse
|
3
|
Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters. J Vasc Interv Radiol 2009; 20:S374-6. [DOI: 10.1016/j.jvir.2009.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 12/21/2004] [Indexed: 11/18/2022] Open
|
4
|
Shem K. Phlegmasia cerulea dolens: rare complication of vena cava filter placement in man with paraplegia. J Spinal Cord Med 2008; 31:398-402. [PMID: 18959358 PMCID: PMC2582430 DOI: 10.1080/10790268.2008.11760743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To describe a complication of placement of an inferior vena cava (IVC) filter in a man with paraplegia. DESIGN Case report. PARTICIPANTS/METHODS A 48-year-old man with T11 paraplegia secondary to an L1 burst fracture underwent thoracic spinal fusion. The postoperative course was complicated by deep vein thrombosis (DVT) of the right common femoral vein, which was treated with warfarin. RESULTS During rehabilitation, the hematocrit declined, and fluctuance was noted along the surgical site. Computed tomographic scan suggested a hematoma in the paraspinal and latissimus dorsi muscles. Warfarin was discontinued, and an IVC filter was placed. He subsequently developed severe leg pain, followed by hypotension, acute renal failure, and compartment syndrome in bilateral lower extremities requiring fasciotomies. Ultrasound and computed tomographic angiogram showed extensive bilateral lower extremity DVTs and pulmonary emboli. The diagnosis of cerulea dolens was made. Mechanical and pharmacological thrombectomy was aborted secondary to bleeding complications and hypotension. The patient died shortly after care was withdrawn at the family's request. The autopsy revealed multiple thrombi in IVC, bilateral pelvic and femoral veins, and left pulmonary artery embolus, consistent with phlegmasia cerulea dolens. CONCLUSIONS Inferior vena cava filters may prevent pulmonary embolism but do not affect the underlying thrombotic process. An IVC filter should be recognized as a possible thrombogenic nidus in patients with spinal cord injury who have known DVT.
Collapse
Affiliation(s)
- Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California 95128, USA.
| |
Collapse
|
5
|
Millward SF, Grassi CJ, Kinney TB, Kundu S, Becker GJ, Cardella JF, Martin LG, Silberzweig JE, Sacks D. Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters. J Vasc Interv Radiol 2005; 16:441-3. [PMID: 15802441 DOI: 10.1097/01.rvi.0000156096.22103.18] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Steven F Millward
- Department of Diagnostic Imaging, Peterborough Regional Health Centre, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Deep vein thrombosis (DVT) occurs in one-quarter of a million individuals annually in the United States and results in significant disability from pulmonary embolism and chronic venous insufficiency, especially when the proximal iliofemoral is involved. Treatment has centered on early institution of adequate anticoagulation to prevent thrombus propagation and embolism, but anticoagulation alone does not always restore venous patency and many patients are left with venous outflow obstruction and valvular incompetence-the anatomic underpinnings of the postthrombotic syndrome. Various strategies have been used to restore patency of thrombosed veins, including open surgical thrombectomy, pharmacological thrombolysis, and percutaneous mechanical thrombectomy. Each modality has benefits and shortcomings. Surgical thrombectomy had previously been abandoned secondary to poor long-term results. More recently, with improved techniques and better patient selection, surgical thrombectomy has regained a therapeutic role in treating acute DVT in young patients with short segment occlusions. The advent of percutaneous techniques has allowed thrombolysis, percutaneous mechanical thrombectomy, and stenting to be used in conjunction with each other-allowing for better resolution of venous clot burden than when an individual modality is used alone. Practitioners who treat patients with DVT should be familiar with all the options available to restore venous patency, preserve valvular function, and thereby minimize the risk of late postthrombotic complications.
Collapse
Affiliation(s)
- Peter Augustinos
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | |
Collapse
|
7
|
Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Retrievable vena cava filter placement during treatment for deep venous thrombosis. Br J Radiol 2003; 76:712-8. [PMID: 14512331 DOI: 10.1259/bjr/30269183] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of our study is to evaluate the safety of insertion and removal of the retrievable vena cava filter and the efficacy of this filter in preventing pulmonary embolism during treatment of stenosis or obstruction of the lower extremity due to deep venous thrombosis. We retrospectively evaluated placement of 10 filters in 6 patients with lower extremity deep venous thrombosis who had undergone various treatments, including those utilizing techniques of interventional radiology. Worsening of or the new formation of pulmonary embolism was prevented in all patients. All attempts at both implantation and retrieval of the filter were safely accomplished. No complication related to filter placement occurred. Filters were left in the vena cava for permanent use when deep venous thrombosis was refractory to treatment. These results demonstrate that both placement and removal of the retrievable vena cava filter can be accomplished safely and that this type of filter is useful to prevent pulmonary embolism during treatment of deep venous thrombosis of the lower extremity. Further, the use of a retrievable vena cava filter might be preferred over that of a temporary vena cava filter, especially if further implantation of a filter becomes necessary since replacement with a permanent filter would not be required when using a retrievable vena cava filter.
Collapse
Affiliation(s)
- T Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
| | | | | | | | | |
Collapse
|
8
|
Recommended Reporting Standards for Vena Caval Filter Placement and Patient Follow-Up. J Vasc Interv Radiol 2003; 14:S427-32. [PMID: 14514858 DOI: 10.1097/01.rvi.0000094616.61428.f5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
Abstract
The ravages of thromboembolic disease continue to plague patients despite improvements in diagnostic imaging and anticoagulation regimens. In certain cases, standard medical therapy for thromboembolism is contraindicated, results in complications, or fails to adequately protect patients from embolic insults. These patients are treated with insertion of inferior vena cava (IVC) filters. Although it appears that IVC filters do reduce long-term pulmonary embolism (PE) rates, there may be a higher associated incidence of IVC thrombosis and lower-extremity deep venous thrombosis (DVT) than with anticoagulation alone. This article will address attributes of the theoretical ideal IVC filter, recently introduced IVC filters, complications of use of IVC filters, and results of recent IVC filter studies. Alternative sites for filter placements are then reviewed, along with use of temporary and retrievable IVC filters and use of IVC filters for prophylactic situations.
Collapse
Affiliation(s)
- Thomas B Kinney
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, Mail Code 8756, San Diego, California 92103, USA.
| |
Collapse
|
10
|
The Recovery Filter. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Abstract
PURPOSE To evaluate preliminary clinical experience in humans with the Recovery nitinol filter (RNF) for the inferior vena cava, especially the efficacy of the device and safety of its retrieval. MATERIALS AND METHODS Thirty-two patients were followed up to assess for filter efficacy and for ability to remove the filter. RESULTS Sixteen men and 16 women aged 18-83 years (mean, 53 years) underwent treatment with the RNF. Indications for placement were recent pulmonary embolism (n = 16), recent deep venous thrombosis (n = 20), and/or prophylaxis (n = 2). Four patients had contraindications to anticoagulant therapy, and four had complications from anticoagulant therapy. The filter was successfully placed in 32 patients. In 24 (100%) of 24 patients, the filter was successfully retrieved with a jugular approach. The mean implantation period was 53 days (range, 5-134 days). Trapped thrombus was seen within the filter in seven cases. In one patient with a large trapped thrombus, the filter was noted to have migrated 4 cm cephalad. There were no episodes of pulmonary embolism or insertion-site thrombosis. CONCLUSION This preliminary experience in humans confirms the efficacy of the RNF. It also demonstrates the feasibility and safety of retrieval up to 134 days after implantation.
Collapse
Affiliation(s)
- Murray R Asch
- Department of Medical Imaging, Mount Sinai Hospital/University Health Network, 600 University Ave, Suite 564, Toronto, Ontario, Canada M5G 1X5.
| |
Collapse
|
12
|
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.
Collapse
Affiliation(s)
- S F Millward
- Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
13
|
Greenfield LJ, Rutherford RB. Recommended reporting standards for vena caval filter placement and patient follow-up. J Vasc Surg 1999. [DOI: 10.1016/s0741-5214(99)70088-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Greenfield LJ, Rutherford RB. Recommended reporting standards for vena caval filter placement and patient follow-up. Vena Caval Filter Consensus Conference. J Vasc Interv Radiol 1999; 10:1013-9. [PMID: 10496701 DOI: 10.1016/s1051-0443(99)70185-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- L J Greenfield
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | | |
Collapse
|
15
|
Rossi P, Arata FM, Bonaiuti P, Pedicini V. Fatal outcome in atrial migration of the Tempofilter. Cardiovasc Intervent Radiol 1999; 22:227-31. [PMID: 10382055 DOI: 10.1007/s002709900372] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the risk of fatal atrial migration with the Tempofilter. METHODS Among temporary filters, the high safety profile Tempofilter has been marketed as offering protection for up to 6 weeks. We implanted about 60 Tempofilters to prevent pulmonary embolism. The main indications were temporary thromboembolic risk, recurrent pulmonary embolism, and contraindication to or failure of anticoagulant therapy. Follow-up was performed regularly by plain abdominal film and Doppler ultrasound. Filters were removed about 4 weeks after placement. RESULTS We encountered three cases (5%) of atrial migration and one case of 5-cm cephalad displacement of the filter. Of the three patients with atrial migration, two died within 3 days of implantation, one from a massive pulmonary embolism and the other with cardiac tamponade. One patient did not show any serious complications. CONCLUSIONS The Tempofilter may actively migrate cranially and become dangerous in the case of migration within the heart.
Collapse
Affiliation(s)
- P Rossi
- Department of Radiology, III Chair, University of Rome La Sapienza, Policlinico Umberto I, Italy
| | | | | | | |
Collapse
|
16
|
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.
Collapse
Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
| | | | | | | | | |
Collapse
|
17
|
Angle JF, Matsumoto AH, Al Shammari M, Hagspiel KD, Spinosa DJ, Humphries JE. Transcatheter regional urokinase therapy in the management of inferior vena cava thrombosis. J Vasc Interv Radiol 1998; 9:917-25. [PMID: 9840035 DOI: 10.1016/s1051-0443(98)70422-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study the efficacy of local infusion of urokinase (UK) in the treatment of symptomatic inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS Eight patients (five men and three women) who ranged in age from 19 years to 75 years (mean, 56 years) with symptomatic IVC thrombosis underwent local catheter-directed infusion of UK with use of up to three access sites. Infrarenal IVC thrombus and iliac vein thrombus was identified in all patients. Four patients had extension of thrombus proximal to the renal veins. Seven of eight patients had at least one risk factor for IVC thrombosis: hypercoagulable state (n = 3), IVC filter (n = 3), malignancy (n = 2), recent surgery (n = 2), and oral contraceptive use (n = 1). No serious procedure-related complications were encountered, although one patient died 5 days after UK therapy of pulmonary failure due to advanced lung cancer. UK was infused for an average of 79 hours (range, 24-140 hours) and a mean total dose of 7.4 million U of UK (range, 2.9-14.4 million U). Adjunctive balloon angioplasty was performed in three patients. No vascular stents were placed. Clinical and/or radiographic follow-up was obtained in all eight patients. RESULTS Thrombolysis was successful in seven of eight (88%) IVCs with no or minimal residual thrombus. The remaining seven patients had no lower extremity swelling 2-24 months (mean, 11 months) after the procedure. Three of seven patients had computed tomographic or venographic follow-up (mean, 9 months; range, 1.5-15 months), demonstrating unchanged or improved IVC patency. CONCLUSIONS Transcatheter regional infusion of UK for re-establishing venous patency in acute IVC thrombosis appears to be effective with good short-term and mid-term clinical benefit.
Collapse
Affiliation(s)
- J F Angle
- University of Virginia, Health Sciences Center, Charlottesville 22908, USA
| | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- S F Millward
- Department of Diagnostic Imaging, University of Ottawa, Ottawa Civic Hospital, Ontario, Canada
| |
Collapse
|
19
|
Ryu RK, Durham JD, Kumpe DA. Transcatheter venous thrombolysis--pitfalls and pratfalls: a case discussion of indications, technique, and alternatives. J Vasc Interv Radiol 1997; 8:1005-10. [PMID: 9399470 DOI: 10.1016/s1051-0443(97)70702-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- R K Ryu
- University of Colorado School of Medicine, Section of Interventional Radiology, Denver, USA
| | | | | |
Collapse
|