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Montoya C, Rey J, Polania-Sandoval CA, Bornak A, Shao T, Kenel-Pierre S. Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review. Vasc Endovascular Surg 2024; 58:559-566. [PMID: 38196287 DOI: 10.1177/15385744231226048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION AND IMPORTANCE Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. CASE PRESENTATION A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. CLINICAL FINDINGS AND INVESTIGATIONS The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. INTERVENTION AND OUTCOMES The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. RELEVANCE AND IMPACT Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jorge Rey
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | | | - Arash Bornak
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Tony Shao
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Stefan Kenel-Pierre
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
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Haddad P, Peng J, Drake M, Rahimi M. Inferior Vena Cava Filters: An Overview. Methodist Debakey Cardiovasc J 2024; 20:49-56. [PMID: 38765211 PMCID: PMC11100533 DOI: 10.14797/mdcvj.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 05/21/2024] Open
Abstract
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
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Affiliation(s)
- Paul Haddad
- Houston Methodist Hospital, Houston, Texas, US
| | | | | | - Maham Rahimi
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Kurzyna P, Banaszkiewicz M, Florczyk M, Kępski J, Piłka M, Kędzierski P, Mańczak R, Szwed P, Kasperowicz K, Wrona K, Doroszewski G, Torbicki A, Kurzyna M, Szmit S, Darocha S. Safety and Outcomes of Inferior Vena Cava Filter Placement in Oncology Patients: A Single-Centre Experience. Cancers (Basel) 2024; 16:1562. [PMID: 38672644 PMCID: PMC11049443 DOI: 10.3390/cancers16081562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The risk of venous thromboembolism (VTE) in the oncology population is significantly higher than in non-cancer patients. Inferior vena cava (IVC) filters may, therefore, be an important part of VTE treatment. In this study, we address the outcomes of placing IVC filters in the oncology population. This single-centre, observational, retrospective study included 62 patients with active malignancy and acute VTE who underwent an IVC filter implantation due to contraindications to anticoagulation during the period 2012-2023. The control group consisted of 117 trauma patients. In both groups, an urgent surgical procedure requiring temporary cessation of anticoagulation was the most noted reason for IVC filter placement-76% in the oncology group vs. 100% in the non-oncology group (p < 0.001). No complications were reported during the IVC filter implantation procedures. There was no recurrence of pulmonary embolism or deep venous thrombosis in the oncology group after filter implantation. The rate of successful filter explantation, median time to retrieval, and abnormal findings during retrieval were not significantly different between both subgroups (64.3% vs. 76.5%, p = 0.334; 77 days vs. 84 days, p = 0.764; 61.5% vs. 54.2%, p = 0.672; respectively). The study showed that IVC filter placement is a safe and effective method of preventing PE in cancer patients with contraindications to anticoagulation. The complication rate following IVC filter implantation in cancer patients is low and similar to that in non-oncology patients.
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Affiliation(s)
- Paweł Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Jarosław Kępski
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Szwed
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Krzysztof Kasperowicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Katarzyna Wrona
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Grzegorz Doroszewski
- Centre of Postgraduate Medical Education, Pelvic Injury and Pathology Department, Konarskiego 13, 05-400 Otwock, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Sebastian Szmit
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
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Wang C, Liu Q, Xiao D, Chen X, Liu R, Wang S. Laparoscopic-assisted retrieval of inferior vena cava filter: A case report and literature review. Vascular 2024:17085381241241108. [PMID: 38498983 DOI: 10.1177/17085381241241108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The retrieval of inferior vena cava filters beyond the retrieval window poses challenges, requiring alternative techniques. OBJECTIVES To discuss the laparoscopy-assisted retrieval approach for difficult inferior vena cava filters. RESEARCH DESIGN Case report. SUBJECTS A 57-year-old male with a retrievable inferior vena cava filter placed 8 months prior. MEASURES Laparoscopy-assisted retrieval technique utilized after unsuccessful interventional attempts. RESULTS Successful retrieval of the filter despite thickened intimal tissue involvement, with no postoperative complications. CONCLUSIONS Laparoscopy-assisted retrieval offers a direct visual approach for challenging filter removal, proving minimally invasive, safe, and effective.
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Affiliation(s)
| | | | - Dalei Xiao
- Luohe Central Hospital, Luohe City, China
| | | | - Rong Liu
- Luohe Central Hospital, Luohe City, China
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El Dick J, Shah P, Paul AK. Utilization Practices of Inferior Vena Cava Filters at an Academic Medical Center. Cureus 2024; 16:e55505. [PMID: 38571863 PMCID: PMC10990477 DOI: 10.7759/cureus.55505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Anticoagulation is the mainstay of management for patients with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Inferior vena cava (IVC) filters are indicated in select patients who are not candidates for anticoagulation. There is a lack of quality evidence supporting other indications. In addition, long-term benefits and safety profiles of IVC filters have not been established. We investigated the utilization practice of IVC filters in a contemporary series of patients in a tertiary academic medical center. METHODOLOGY A retrospective review of 200 patients who received IVC filters at Virginia Commonwealth University (VCU) Medical Center in the years 2017 and 2018 was conducted. Adult patients 18 years of age or older with or without cancer were included, and patients were selected consecutively until data on 200 patients were collected. Data on patient demographics, an indication of IVC filter placement, filter retrieval rate, and re-thrombosis events over a median follow-up period of nine months were extracted from the electronic medical record and analyzed. RESULTS A total of 200 patients (105 male and 95 female) were included with a median age of 61 years (range 17-92 years). Of the 200 patients, 97 (48.5%) had a DVT, 28 (14%) had a PE, 73 (36.5%) had both a PE and DVT, and 2 (1%) had thrombosis at other sites. A total of 130 (65%) patients had an IVC filter placed because of a contraindication to anticoagulation, while 70 (35%) had an IVC filter placed for other nonstandard indications, which included new or worsening VTE despite anticoagulation, recent VTE who must have anticoagulation held during surgery, primary prevention in high-risk patients, and extensive disease burden among other reasons. Seventy-two (36%) patients had active malignancy at the time of filter placement, and 64 (32%) were lost to follow-up. Of the 119 patients who were potentially eligible for filter retrieval, 55 (46%) patients had their IVC filters removed at a median of five months after insertion. Of the 55 patients who had IVC filters removed, 8 (14.5%) patients experienced a re-thrombosis event within a median follow-up of 39 months. Of the 145 patients who still had their filter in place at the time of death or last follow-up, 5 (3.4%) patients experienced a re-thrombosis event within a median follow-up of three months. CONCLUSIONS One-third of the patients in this series had an IVC filter placed without a standard indication, and less than half of them had the IVC filters removed within one year of placement. Additionally, one-third of the patients were lost to follow-up, highlighting the need for improved structured follow-up programs and education among both patients and providers regarding the indications for placement and retrieval to minimize complications.
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Affiliation(s)
- Joud El Dick
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, USA
| | - Palak Shah
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Medical Center, Richmond, USA
| | - Asit Kr Paul
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Medical Center, Richmond, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Wu YL, Yang GK, Chen Q, Tang Y, Zhang JH, Wu SJ, Cai SL, Zhou YF, Zhu YB, Luo JW, Fang ZT. Case Report: Imaging features of a new type double inferior vena cava malformation and review. Front Cardiovasc Med 2023; 10:1298071. [PMID: 38111887 PMCID: PMC10726045 DOI: 10.3389/fcvm.2023.1298071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023] Open
Abstract
Background Double inferior vena cava (DIVC) is a rare vascular malformation. With advances in radiological techniques and diagnosis, more and more types of DIVC were identified and diagnosed. Recognition of the variety of DIVC seen on imaging is essential for subsequent venous interventions. Case presentation A 77-year-old man presented with low back pain with left lower limb pain for 1 month. Scattered petechiae above the skin surface on the left lower leg, especially on the extensor surface, with flaking and mild tingling of the skin, were noted 3 weeks ago. Ultrasound revealed deep vein thrombosis (DVT) in the left lower limb. Computed tomography pulmonary angiography (CTPA) suggested no significant thrombus in the pulmonary artery. Computed tomography venography (CTV) of bilateral lower limbs showed that iliac vein compression syndrome with formation of deep and superficial venous traffic branches in bilateral lower limbs, predominantly on the left side. CTV of the inferior vena cava (IVC) suggested that the left common iliac vein crossed the common iliac artery bifurcation from dorsal to ventral and continued to travel cranially as a ventral vessel, and connected with the ventral IVC anterior to the right common iliac artery. The right common iliac vein extended cephalad as a dorsal vessel, which was narrowed at the level of 4th lumbar vertebra by compression of the hyperplastic bone and the osteophyte. The patient was discharged after right and left common iliac vein angiography and balloon dilation of bilateral common iliac vein. Conclusion The formation of both ventrally and dorsally aligned DIVC is rarer. It should be clarified the effects of DIVC on DVT formation, and the importance of imaging for preoperative planning.
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Affiliation(s)
- Yu-lin Wu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Guo-kai Yang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Qian Chen
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jian-hui Zhang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shao-jie Wu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Sen-lin Cai
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Yan-feng Zhou
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Yao-Bin Zhu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie-wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Zhu-ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
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Yamada N, Fukuda I, Nakamura M, Takayama M, Maeda H, Yamashita T, Ikeda T, Mo M, Yamazaki T, Okumura Y, Hirayama A. Prognostication of Patients with Pulmonary Thromboembolism with and without Residual Deep Vein Thrombosis: A Subanalysis of the J'xactly Study. Ann Vasc Dis 2023; 16:181-188. [PMID: 37779650 PMCID: PMC10539124 DOI: 10.3400/avd.oa.22-00111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/04/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: It is unclear whether patients with acute pulmonary thromboembolism (PE) with and without residual deep vein thrombosis (DVT) have different prognoses, and there is debate over whether inferior vena cava filters (IVCFs) should be used in conjunction with oral anticoagulants in patients with venous thromboembolism (VTE). Materials and Methods: The J'xactly involved 1,016 patients and was a multicenter, prospective, observational research. In this subanalysis, 419 patients with PE with or without residual DVT who received rivaroxaban with or without IVCFs between February 2016 and April 2018 in Japan were examined. Results: Of 419 patients with PE, 320 had residual DVT. There was no difference between the groups with and without DVT in terms of the percentage of patients who experienced symptomatic PE recurrence (2.8% [9/320] vs. 3.0% [3/99]) or who died from VTE-related complications (0.9% [3/320] vs. 1.0% [1/99]). The percentages of patients with symptomatic PE recurrence were 0% and 3.2%, and the percentages of patients who died from VTE-related causes were 0% and 1.1%, respectively, in the groups with (n=39) and without (n=281) IVCF, albeit not being statistically different. Conclusion: Patients with PE with and without residual DVT did not have a different incidence of symptomatic PE recurrence. These results require additional study to be confirmed.
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Affiliation(s)
- Norikazu Yamada
- Department of Cardiology, Kuwana City Medical Center, Kuwana, Mie, Japan
| | - Ikuo Fukuda
- Department of Cardiology, Keimeikai Yokawa Hospital, Miki, Hyogo, Japan
| | | | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Hideaki Maeda
- Department of Heart and Vascular Center, Ukima Central Hospital, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tsutomu Yamazaki
- Innovation and Research Support Center, International University of Health and Welfare, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Osaka Police Hospital, Osaka, Osaka, Japan
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Gong M, Jiang R, Zhao B, Kong J, Liu Z, Qian C, He X, Gu J. Relationship between vascular access and angulation of vena cava filter at placement and retrieval: a multicenter retrospective cohort study. Ther Adv Chronic Dis 2023; 14:20406223231200254. [PMID: 37745816 PMCID: PMC10515605 DOI: 10.1177/20406223231200254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Inferior vena cava (IVC) filters are commonly used intravascular devices designed to prevent fatal pulmonary embolism (PE), maintaining the IVC filter as centered as possible is fundamental for achieving its filtration function. Objective This study aimed to characterize the tilt angles of IVC filter between the vascular access of internal jugular vein (IJV) and femoral vein (FV), as well as to identify factors associated with increased or decreased tilt angles between placement and retrieval. Design This is a multicenter retrospective study. Methods A multicenter retrospective study was conducted from October 2017 to March 2019. The primary outcome was the change in filter tilt between placement and retrieval. The secondary outcome was the identifications of factors associated with increased or decreased tilt angle. Relevant variables were analyzed using t-tests, Chi-square tests, Fisher's exact tests, while multivariate logistic regression analysis was used to determine risk factors. Results A total of 184 eligible patients were included in this study. The IJV group had a lower likelihood of tilt angle over 10° at the time of placement compared to the FVs group (0% versus 12.5%, p = 0.040). Among the 171 patients with a mean dwell time of 22.1 days, the IJV group had a higher likelihood of tilt angle over 10° than the FVs group (10.3% versus 2.3%, p = 0.080). The use of FVs access at placement was associated with a higher difference between placement and retrieval filter tilt angles (p < 0.01). Multivariate logistic regression analysis showed that hypertension [odds ratio (OR) 0.668; 95% confidence interval (CI) 0.328-1.358, p = 0.265], cardiologic artery disease (OR 0.537; 95% CI 0.136-2.130, p = 0.377), cerebral venous disease (OR 0.555; 95% CI 0.186-1.651, p = 0.290), filter types (OR 1.624; 95% CI 0.851-3.096, p = 0.141), and IVC filter thrombosis (OR 1.634; 95% CI 0.804-3.323, p = 0.175) were not associated with increased filter tilt angle. Right side (OR 0.434; 95% CI 0.202-0.930, p = 0.032) or bilateral lower extremity deep vein thrombosis (LEDVT) (OR 0.383; 95% CI 0.148-0.995, p = 0.049) were identified as protective factors. Conclusion IJV access was associated with a lower filter tilt angle at the time of placement, while FVs access was linked to a higher difference between placement and retrieval tilt angles. Right side or bilateral LEDVT were identified as protective factors against increased IVC filter tilt angle.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Rui Jiang
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Boxiang Zhao
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Jie Kong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Zhengli Liu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Cheng Qian
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P. R. China
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Cornman-Homonoff J, Lozada JCP, Marino AG, Mojibian H. Use of a funneled sheath for embolic protection during removal of thrombosed Simon Nitinol filters. Diagn Interv Radiol 2023; 29:733-735. [PMID: 37593925 PMCID: PMC10679551 DOI: 10.4274/dir.2023.232267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
Inferior vena cava (IVC) filters should be removed when no longer needed, given their association with complications such as thrombosis of the IVC and lower extremities, fracture, migration, and growth into adjacent structures. While this is generally straightforward in the setting of retrievable filters, permanent filters present more of a challenge. In fact, many operators will not attempt to do so for fear of intraprocedural complications, among them, filter fracture and fragment embolization. Despite this, leaving the filters in situ places patients at risk of the complications described above. Here, the authors illustrate a novel technique for retrieving permanent filters using a funneled sheath to protect against embolization.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Juan Carlos Perez Lozada
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Angelo G Marino
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
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11
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Burt JN, Hirsh JD, Panchal RM, Endler GT, Devalla RN, Mitchell ME, Villalobos MA. Inferior Vena Cava Filter Occlusion Causing Phlegmasia Alba Dolens. Am Surg 2023; 89:3915-3916. [PMID: 37204767 DOI: 10.1177/00031348231177929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Phlegmasia alba dolens is a rare sequela of acute extensive venothrombus of the iliofemoral segments. Rarely, phlegmasia alba dolens can also result from clotted inferior vena cava filter. A 39-year-old with protein S deficiency, and prior inferior vena cava filter placement after remote trauma presented to the emergency department with progressive bilateral lower extremity pain and swelling. Venous duplex revealed extensive bilateral deep vein thromboses from the external iliac veins to popliteal veins, as well as thrombophlebitis of the left great saphenous vein. Venography confirmed patency of the suprarenal vena cava with abrupt occlusion of the infrarenal segment at the level of the inferior vena cava filter. The filter was removed followed by endovascular thrombectomy and adjunctive venoplasty. The patient progressed well and discharged on therapeutic anticoagulation. This case illustrates that a staged endovascular approach may be utilized for acute on chronic caval thrombosis and filter removal.
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Affiliation(s)
- Jeremy N Burt
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Joshua D Hirsh
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Ramola M Panchal
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Graham T Endler
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Raviteja N Devalla
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Marc E Mitchell
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
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12
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Kolahdouz EM, Wells DR, Rossi S, Aycock KI, Craven BA, Griffith BE. A sharp interface Lagrangian-Eulerian method for flexible-body fluid-structure interaction. J Comput Phys 2023; 488:112174. [PMID: 37214277 PMCID: PMC10194997 DOI: 10.1016/j.jcp.2023.112174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper introduces a sharp-interface approach to simulating fluid-structure interaction (FSI) involving flexible bodies described by general nonlinear material models and across a broad range of mass density ratios. This new flexible-body immersed Lagrangian-Eulerian (ILE) scheme extends our prior work on integrating partitioned and immersed approaches to rigid-body FSI. Our numerical approach incorporates the geometrical and domain solution flexibility of the immersed boundary (IB) method with an accuracy comparable to body-fitted approaches that sharply resolve flows and stresses up to the fluid-structure interface. Unlike many IB methods, our ILE formulation uses distinct momentum equations for the fluid and solid subregions with a Dirichlet-Neumann coupling strategy that connects fluid and solid subproblems through simple interface conditions. As in earlier work, we use approximate Lagrange multiplier forces to treat the kinematic interface conditions along the fluid-structure interface. This penalty approach simplifies the linear solvers needed by our formulation by introducing two representations of the fluid-structure interface, one that moves with the fluid and another that moves with the structure, that are connected by stiff springs. This approach also enables the use of multi-rate time stepping, which allows us to use different time step sizes for the fluid and structure subproblems. Our fluid solver relies on an immersed interface method (IIM) for discrete surfaces to impose stress jump conditions along complex interfaces while enabling the use of fast structured-grid solvers for the incompressible Navier-Stokes equations. The dynamics of the volumetric structural mesh are determined using a standard finite element approach to large-deformation nonlinear elasticity via a nearly incompressible solid mechanics formulation. This formulation also readily accommodates compressible structures with a constant total volume, and it can handle fully compressible solid structures for cases in which at least part of the solid boundary does not contact the incompressible fluid. Selected grid convergence studies demonstrate second-order convergence in volume conservation and in the pointwise discrepancies between corresponding positions of the two interface representations as well as between first and second-order convergence in the structural displacements. The time stepping scheme is also demonstrated to yield second-order convergence. To assess and validate the robustness and accuracy of the new algorithm, comparisons are made with computational and experimental FSI benchmarks. Test cases include both smooth and sharp geometries in various flow conditions. We also demonstrate the capabilities of this methodology by applying it to model the transport and capture of a geometrically realistic, deformable blood clot in an inferior vena cava filter.
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Affiliation(s)
- Ebrahim M. Kolahdouz
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, NY, USA
| | - David R. Wells
- Department of Mathematics, University of North Carolina, Chapel Hill, NC, USA
| | - Simone Rossi
- Department of Mathematics, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth I. Aycock
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Brent A. Craven
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Boyce E. Griffith
- Departments of Mathematics and Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
- Carolina Center for Interdisciplinary Applied Mathematics, University of North Carolina, Chapel Hill, NC, USA
- Computational Medicine Program, University of North Carolina, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
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13
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Gabara C, Montoya-Rodes M, López N, Zamora-Martínez C, Ortiz M, Morancho A, Moisés J, Osorio J, Coloma E, Font C, Jiménez S, Zarco F, Burrel M, Bermúdez P, Barrufet M, Aibar J. Inferior Vena Cava Filters: Adherence to Clinical Practice Guidelines Recommendations, Retrieval Rates, and Filter Complications in a Tertiary Hospital. Angiology 2023:33197231190184. [PMID: 37470426 DOI: 10.1177/00033197231190184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The present study evaluated the adherence to guideline recommendations regarding the indication for inferior vena cava filter (IVCF) placement, retrieval rates, complications, thrombotic recurrences, and mortality. Patients in whom an IVCF was placed between 2015 and 2020 in a tertiary hospital were retrospectively included. We considered absolute indication of IVCF placement if all the guidelines evaluated agreed on the indication, relative indication if only some guidelines recommended it and without indication if none of the evaluated guidelines recommended it. From the 185 patients included; 47% had an absolute indication, 15% a relative indication, and 38% had no indication. Filter-associated complications and non-removal rates were 12.4% and 41%, respectively. Venous thromboembolism recurrence rate was 17.8%, being filter-associated complications (24.2 vs 9.8%, P = .02) and thrombosis of the inferior cava or iliac veins (12.1 vs 2.6%, P = .03) more frequent in this group. The mortality rate was 40%, with higher mortality risk in patients with co-existing cancer. Previous major bleeding, filter-associated complications, and mortality were associated with a major risk of non-removal. In conclusion, the adherence to guidelines regarding the indication of IVCF placement is still low and IVCF complications are not negligible. This fact is of special concern in the elderly, comorbid, and cancer patients.
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Affiliation(s)
- Cristina Gabara
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Néstor López
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martínez
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Alma Morancho
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jorge Moisés
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jeisson Osorio
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carme Font
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Sonia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Federico Zarco
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Burrel
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Patricia Bermúdez
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Barrufet
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
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14
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Deshmukh A, Parmar G, Lozada JCP, Cornman-Homonoff J. Direct superior vena cava puncture for inferior vena cava filter retrieval. Diagn Interv Radiol 2023; 29:638-639. [PMID: 36976151 PMCID: PMC10679639 DOI: 10.4274/dir.2022.221551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 01/14/2023]
Abstract
Most inferior vena cava (IVC) filters are designed for retrieval from a superior approach. Retrieval becomes technically challenging when the central veins in the chest are occluded. In a patient with thrombosis of the bilateral brachiocephalic veins, the authors describe direct puncture of the superior vena cava (SVC) under fluoroscopy, followed by the successful retrieval of a fractured IVC filter using forceps. A snare inserted into the SVC via the common femoral vein was used as a radiopaque target for direct SVC puncture from the lower neck. Cone beam computed tomography and pullback tractography were used to confirm a safe access trajectory. Thus, direct SVC access may be used for filter retrieval in similar clinical scenarios.
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Affiliation(s)
- Ashwin Deshmukh
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, USA
| | - Gaurav Parmar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, USA
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15
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Golemi L, Chitturu N, Patel H, Chen Y, Hussein A. Navigating Complex Anatomy During Leadless Pacemaker Implantation. JACC Case Rep 2023; 18:101912. [PMID: 37545684 PMCID: PMC10401061 DOI: 10.1016/j.jaccas.2023.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023]
Abstract
Transvenous pacemakers may lead to wound site complications, such as hematomas and infections. Leadless pacemakers have eliminated these risks. However, when the central venous and/or cardiac anatomy are challenging, their implantation technique may require modification(s). Here, we discuss 3 cases of successful leadless pacemaker implantation in patients with a challenging anatomy. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | | | - Ahmed Hussein
- Address for correspondence: Dr Ahmed Hussein, Saint Louis University Hospital, 1201S Grand Blvd, St. Louis, Missouri 63014, USA.
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16
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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.
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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
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17
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Ramachandran R, Kumar V, Grantham T, Etienne D, Reddy M. Conservative Management of Duodenal Penetration by Inferior Vena Cava Filter: Case Report and Review. J Investig Med High Impact Case Rep 2023; 11:23247096231192815. [PMID: 37610107 PMCID: PMC10460035 DOI: 10.1177/23247096231192815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Duodenal penetration is a late complication associated with the placement of inferior vena cava (IVC) filters. In this case report, we are presenting a case of asymptomatic duodenal penetration by IVC filter that was managed conservatively.
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Affiliation(s)
| | - Vikash Kumar
- Department of Internal Medicine, The Brooklyn Hospital Center, NY, USA
| | - Tyler Grantham
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Denzil Etienne
- Department of Gastroenterology, The Brooklyn Hospital Center, NY, USA
| | - Madhavi Reddy
- Department of Gastroenterology, The Brooklyn Hospital Center, NY, USA
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18
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Li T, Wang Q, Wang W, Yang J, Dong S. One filter may be enough for duplicate inferior vena cava filter implantation in patients with deep venous thrombosis: Two cases report. Medicine (Baltimore) 2022; 101:e32480. [PMID: 36596001 PMCID: PMC9803440 DOI: 10.1097/md.0000000000032480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Duplicate inferior vena cava (IVC) is an uncommon congenital malformation, but should be treated carefully under the circumstances of deep venous thrombosis (DVT). However, there is a paucity of clinical guidance on this situation. METHODS Duplicate IVC was diagnosed based on the imaging examination that revealed the dual IVC. Deep venous thrombosis was diagnosed by Compression Doppler ultrasonography of both lower extremities with the high-elevated D-dimer. Retrievable IVC filters were implanted to prevent massive and fatal pulmonary embolism. Appropriate anticoagulation therapy was also performed. RESULTS Two retrievable filters were successfully implanted and retrieved in two patients with deep venous thrombosis and duplicate inferior vena cava, respectively. During further follow-up, no adverse event was reported. CONCLUSION Comprehensive imaging examination might contribute to the diagnosis of duplicate IVC, especially when individual conditions were limited. The position above the confluence of bilateral IVCs might be an appropriate suprarenal retrievable filter insertion location. To deal with different types of dual IVC anatomy, different strategies should be taken into consideration.
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Affiliation(s)
- Tao Li
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuilin Dong
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * Correspondence: Shuilin Dong, Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China (e-mail: )
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19
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Shreve LA, Lam A, Badin D, Nelson K, Katrivesis J, Fernando D, Abi-Jaoudeh N. Changes in perfusion angiography after IVC filter placement and retrieval. Medicine (Baltimore) 2022; 101:e31600. [PMID: 36550909 PMCID: PMC9771224 DOI: 10.1097/md.0000000000031600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Inferior vena cava (IVC) filters are posited to effect flow dynamics, causing turbulence, vascular remodeling and eventual thrombosis; however, minimal data exists evaluating hemodynamic effects of IVC filters in vivo. The purpose of this study was to determine differences in hemodynamic flow parameters acquired with two-dimension (2D)-perfusion angiography before and after IVC filter placement or retrieval. 2D-perfusion images were reconstructed retrospectively from digital subtraction angiography from a cohort of 37 patients (13F/24M) before and after filter placement (n = 18) or retrieval (n = 23). Average dwell time was 239.5 ± 132.1 days. Changes in the density per pixel per second within a region of interest (ROI) were used to calculate contrast arrival time (AT), time-to-peak (TTP), wash-in-rate (WIR), and mean transit time (MTT). Measurements were obtained superior to, inferior to, and within the filter. Differences in hemodynamic parameters before and after intervention were compared, as well as correlation between parameters versus filter dwell time. A P value with Bonferroni correction of <.004 was considered statistically significant. After placement, there was no difference in any 2D-perfusion variable. After retrieval, ROIs within and inferior to the filter showed a significantly shorter TTP (1.7 vs 1.4 s, P = .004; 1.5 vs 1.3 s, P = .001, respectively) and MTT (1.7 vs 1.4 s, P = .003; 1.5 vs 1.2 s, P = .002, respectively). Difference in variables showed no significant correlation when compared to dwell time. 2D-perfusion angiography is feasible to evaluate hemodynamic effects of IVC filters in vivo. TTP and MTT within and below the filter after retrieval were significantly changed, without apparent correlation to dwell time, suggesting a functional hemodynamic delay secondary to filter presence.
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Affiliation(s)
- Lauren A. Shreve
- Department of Radiological Sciences, University of Pennsylvania, Philadelphia, PA, USA
- *Correspondence: Lauren Shreve, Department of Radiological Sciences, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein Suite 130, Philadelphia, PA, 19104. (e-mail: )
| | - Alexander Lam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dylan Badin
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Kari Nelson
- Department of Radiology, Vascular and Interventional Radiology, Saddleback Memorial Medical Center, Laguna Hills, CA, USA
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
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Kuraoka N, Ujihara T, Hashimoto S. A case of cholestasis caused by inferior vena cava filter. J Hepatobiliary Pancreat Sci 2022; 29:e122-e123. [PMID: 35851574 DOI: 10.1002/jhbp.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/26/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
Cholestasis and obstructive jaundice can be caused by several factors. Kuraoka et al. report an extremely rare case of cholestasis due to occlusion of the distal bile duct by an inferior vena cava filter, which was confirmed on imaging. Jaundice improved after placement of a biliary stent.
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Affiliation(s)
- Naosuke Kuraoka
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Satoru Hashimoto
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
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21
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Muacevic A, Adler JR. Effectiveness and Safety of Laser-Assisted Removal of Inferior Vena Cava (IVC) Filters in a Single Tertiary Care Center. Cureus 2022; 14:e32809. [PMID: 36570113 PMCID: PMC9773150 DOI: 10.7759/cureus.32809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Laser sheath-assisted removal of inferior vena cava (IVC) filters with long dwelling time is a technique that utilizes laser-tipped sheaths. The laser light only penetrates vascular tissue by one hundred microns, causing the target tissues to disintegrate into particles less than 5 microns in size. This approach reduces the energy used during difficult retrieval procedures, allowing permanent filters to be removed in less fluoroscopic and procedural time overall. MATERIALS AND METHODS The radiology information system and electronic health records were used in this retrospective cohort study to retrieve the data. A total of nine consecutive patients who underwent laser-assisted filter removal utilizing GlideLightTM were included in the study between January 2016 and January 2017. The study took place at King Abdulaziz Medical City in Riyadh. In this study, five patients were male and four were female with ages ranging from 19 to 57 years with a median age of 31. RESULTS During the period of the study, a total of nine patients had their IVC filters removed using a laser. The success rate was 100%. The indications were trauma (n=4) followed by deep vein thrombosis (DVT) (n=3) and one patient indication was prolonged immobilization. The dwelling time ranged from seven to 70 months, with a dwelling median of 19 months. CONCLUSION A laser sheath might be necessary for closed-cell filters in order to improve the likelihood of a successful and secure retrieval. Technical efficiency, filter type, the necessity of applying a laser sheath based on an open versus closed filter design, dwell times, and unfavorable results. As a result, after typical procedures failed to successfully retrieve IVC filters with long dwell durations, laser-assisted filter removal is thought to be practical and safe.
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22
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Gachabayov M, Latifi LA, Latifi R. Do the benefits of prophylactic inferior vena cava filters outweigh the risks in trauma patients? A meta-analysis. Acta Chir Belg 2022; 122:151-159. [PMID: 35044879 DOI: 10.1080/00015458.2022.2031534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis was to evaluate whether the benefits of prophylactic inferior vena cava filters (IVCF) outweigh the risks thereof. PATIENTS AND METHODS PubMed, EMBASE, and Cochrane Library were systematically searched for records published from 1980 to 2018 by two independent researchers (MG, GG). The endpoints of interest were pulmonary embolism (PE) and deep vein thrombosis (DVT) rates. Quality assessment, data extraction and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel-Haenszel method with odds ratio and 95% confidence interval (OR (95%CI)) as the measure of effect size was utilized for meta-analysis. RESULTS Fifteen studies (two randomized controlled trials and 13 observational studies) were included in the meta-analysis. PE rate was 0.9% (11/1183) in IVCF vs. 0.6% (240/39,417) in No IVCF. This difference was not statistically significant [OR (95%CI) = 0.31 (0.06, 1.51); p = 0.15]. DVT rate was 8.4% (77/915) in IVCF vs. 1.7% (653/38,807) in No IVCF. The difference was not statistically significant [OR (95%CI) = 2.67 (0.90, 7.98); p = 0.08]. In the subset of RCTs, PE rate was 0% (0/64) in IVCF vs. 12% (6/5) in No IVCF. This difference was statistically significant [OR (95%CI) = 0.12 (0.01, 1.03); p = 0.05]. CONCLUSIONS This meta-analysis found that prophylactic IVCF may be associated with decreased PE rates at the possible cost of increased DVT rates. Further observational and experimental clinical studies are needed to confirm the findings of this meta-analysis.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A. Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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23
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Kostadinov D, Tzivanakis A, Ubhayakar G, Dixon S, Helyar V, Dayal SP, Mohamed F, Cecil TD, Moran BJ. Indications and long-term outcomes of preoperative inferior vena caval filters in 111 patients at high risk of pulmonary embolism undergoing major abdominal surgery. Colorectal Dis 2021; 23:1982-1988. [PMID: 34092012 DOI: 10.1111/codi.15767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 02/08/2023]
Abstract
AIMS Patients with abdominal cancer requiring major surgical intervention are at high risk of venous thromboembolic events (VTE), particularly pulmonary emboli (PE). A proportion of patients with cancer can present with, or have had, major VTEs prior to definitive surgical treatment. Preoperative percutaneous inferior venal caval filters (IVCF) may reduce the risk of PE. The aim of this study was to assess the indications, complications, retrieval rates, and long-term outcome of IVCFs in patients undergoing major abdominal surgery. METHODS This was a retrospective analysis of a prospective IVCF database between 2007 and 2018 of all patients with IVCF insertion prior to major abdominal surgery. The indications for an IVCF, procedural complications and surgical interventions were recorded. RESULTS Overall, 111 patients had IVCF insertion. IVCF placement failed in one patient with gross abdominal disease. Indications for an IVCF were: prior PE in 65/111 (59%) and major vein thrombus in 42 (38%). Overall, 26/111 (23%) had the IVCF removed at a median of 91 days. In two patients IVCF removal failed. At follow-up of the 85 patients who had the IVCF left in situ, six developed filter-related thrombus and 13 a deep vein thrombosis (DVT). Four patients had a PE with an indwelling IVCF. CONCLUSION Preoperative IVCF may reduce perioperative PE in patients at high risk of thrombosis undergoing major abdominal surgery where early anticoagulation is contraindicated. Long-term follow-up of retained IVCF suggests that major problems are infrequent, though further thrombosis may occur and long-term anticoagulation may be needed.
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Affiliation(s)
- Danko Kostadinov
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Alexios Tzivanakis
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Gaurang Ubhayakar
- Department of Radiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Shaheen Dixon
- Department of Radiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Vincent Helyar
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sanjeev Paul Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Thomas Desmond Cecil
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan John Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Abstract
BACKGROUND Obstructive shock is an uncommon presentation to the emergency department (ED) and is most often caused by an acute pulmonary embolism. A very rare cause of obstructive shock is extensive deep venous thrombosis, otherwise known as phlegmasia cerulea dolens. We present a case of obstructive shock caused by placement of an inferior vena cava filter complicated by acute occlusion with extensive deep venous thrombosis. CASE REPORT A 57-year-old man presented to the ED with hypotension, lethargy, and chronic leg pain. The day prior he had an inferior vena cava filter placed and was taken off his anticoagulation approximately 1 week prior. Massive pulmonary embolism was excluded as the cause based on point-of-care ultrasound showing absence of right heart strain. His initial resuscitation and evaluation did not determine the cause of his shock and he was empirically treated for sepsis. After adequate blood pressure was achieved with norepinephrine, his lower extremities were noted to be cyanotic and an ultrasound revealed the diagnosis of phlegmasia cerulea dolens. The shock state resolved after catheter-directed thrombolysis. Why Should an Emergency Physician Be Aware of This? Although unique, this case highlights an alternative cause of obstructive shock and informs emergency physicians about a potential deadly complication of a common procedure.
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Shah K, Patel S, Hanson I, Williamson B, Kutinsky I, Dixon S, Haines DE, Mehta NK. Navigating inferior vena cava filters in invasive cardiology procedures: A systematic review. J Cardiovasc Electrophysiol 2021; 32:1440-1448. [PMID: 33772931 DOI: 10.1111/jce.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCFs) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in-situ. METHODS Two independent reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time, and procedural specifics. RESULTS Out of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval = 89.54-98.1) with no heterogeneity (I2 = 0%, p = 1) and there were no reported filter-related complications. CONCLUSION This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.
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Affiliation(s)
- Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Sati Patel
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Brian Williamson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Ilana Kutinsky
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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26
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Arslanbekov MM, Efremova OI, Lebedev IS, Kirienko AI, Zolotukhin IA. Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital. Phlebology 2020; 36:450-455. [PMID: 33308030 DOI: 10.1177/0268355520975582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. METHODS We performed a retrospective analysis of database of a tertiary hospital in 2016-2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. RESULTS 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients' anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. CONCLUSIONS Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.
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Affiliation(s)
- Magomed M Arslanbekov
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Oksana I Efremova
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Igor S Lebedev
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Aleksandr I Kirienko
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Igor A Zolotukhin
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
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Kesselman A, Oo TH, Johnson M, Stecker MS, Kaufman J, Trost D. Current Controversies in Inferior Vena Cava Filter Placement: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 216:563-9. [PMID: 33206563 DOI: 10.2214/AJR.20.24817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.
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28
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Wang J, Huang W, Zhou Y, Han F, Ke D, Lee C. Hemodynamic Analysis of VenaTech Convertible Vena Cava Filter Using Computational Fluid Dynamics. Front Bioeng Biotechnol 2020; 8:556110. [PMID: 33195121 PMCID: PMC7661937 DOI: 10.3389/fbioe.2020.556110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
The VenaTech convertible filter (VTCF) has been widely used as an inferior vena cava (IVC) filter to prevent fatal pulmonary embolism in patients. However, its hemodynamics that greatly affect the filter efficacy and IVC patency are still unclear. This paper uses computational fluid dynamics with the Carreau model to simulate the non-Newtonian blood flows around the VTCF respectively deployed in the normal, reverse and three converted states in an IVC model. The results show that the prothrombotic stagnation zones are observed downstream from the normal, reverse and small open VTCFs, with the streamwise length is nearly eight times the IVC diameter. The no-slip boundary conditions of the thin-wire VTCF arms lead to the “viscous block” effect. The viscous block accelerates the blood flow by 5–15% inside the IVC and enhances the filter wall shear stress up to nearly 20 times that of the IVC only, which contributes to clot capture and thrombus lysis. The relative flow resistance is defined to evaluate the filter-induced resistance on the IVC blood flow that can be regarded as an index of IVC patency with the filter deployment. The flow resistance of the normal VTCF deployment increases dramatically by more than 60% compared with that of the IVC only and is a little higher (6%) than that of the reverse case. As the VTCF converts to a fully open configuration, the flow resistance gradually decreases to that of no filter. This work shows that even very thin VTCF arms can result in the viscous block effect and may cause significant hemodynamic impacts on clot capture, potential thrombosis and flow impedance inside the IVC. The present study also shows that CFD is a valuable and feasible in silico tool for analyzing the IVC filter hemodynamics to complement in vivo clinical and in vitro experimental studies.
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Affiliation(s)
- Jingying Wang
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Wen Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Zhou
- School of Aeronautical Science and Engineering, Beihang University, Beijing, China
| | - Fangzhou Han
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Dong Ke
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunhian Lee
- School of Energy and Power Engineering, Shandong University, Jinan, China.,School of Aeronautical Science and Engineering, Beihang University, Beijing, China
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29
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Hadied MO, Hieromnimon M, Kapke J, Nijhawan K, Ha TV, Navuluri R, Ahmed O. Caval pseudoaneurysms following complex inferior vena cava filter removal: Clinical significance and patient outcomes. Vascular 2020; 29:624-629. [PMID: 32998667 DOI: 10.1177/1708538120961217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the incidence and clinical significance of caval pseudoaneurysm and extravasation post-complex inferior vena cava filter retrieval. METHODS A total of 83 patients (70% female, average age 56) underwent complex inferior vena cava filter retrieval between January 2015 and December 2019 utilizing either rigid endobronchial forceps (n = 69, 83%) and/or excimer laser (n = 20, 24%). Procedural variables were recorded. The incidence and size of caval pseudoaneurysms and extravasation along with treatment type and clinical outcomes were analyzed. RESULTS Technical success in all cases was 96% (n = 80). Average fluoroscopy time was 23 min (median: 20.2, range: 0.9-129.5). Average filter dwell time was 85 months (range: 2-316 months). Caval pseudoaneurysm was detected on post-retrieval venography in 10 patients (12%) and frank extravasation occurred in 1 case (1%). Average pseudoaneurysm length and width was 20.4 mm (range: 5-45 mm) and 12.9 mm (range: 4-24 mm), respectively. Pseudoaneurysms occurred most frequently during the removal of Optease (n = 5) and Celect (n = 2) filters. The pseudoaneurysms completely resolved with prolonged (>5 min) balloon angioplasty in all but one instance where a small portion of the pseudoaneurysm persisted. This patient was admitted and observed overnight before being discharged without complication. The solitary case of significant extravasation was effectively managed with immediate stent placement and the patient remained hemodynamically stable. CONCLUSIONS Radiographically detectable caval pseudoaneurysm and extravasation is not uncommon in complex inferior vena cava filter retrieval and, despite being considered a major complication by Society of Interventional Radiology guidelines, can often be managed without stenting or other invasive treatment.
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Affiliation(s)
| | - Mark Hieromnimon
- School of Medicine, University of Illinois Chicago, Chicago, USA
| | - Jordan Kapke
- Division of Interventional Radiology, University of Chicago, Chicago, USA
| | - Karan Nijhawan
- Division of Interventional Radiology, University of Chicago, Chicago, USA
| | - Thuong Van Ha
- Division of Interventional Radiology, University of Chicago, Chicago, USA
| | - Rakesh Navuluri
- Division of Interventional Radiology, University of Chicago, Chicago, USA
| | - Osman Ahmed
- Division of Interventional Radiology, University of Chicago, Chicago, USA
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30
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Arif S, Arif S, Liaqat J, Slehria AUR, Palwa AR. Transvenous Catheter-Based Thrombolysis With Continuous Tissue Plasminogen Activator Infusion for Refractory Thrombosis in a Patient With Behcet's Disease. Cureus 2020; 12:e10049. [PMID: 32983739 PMCID: PMC7515802 DOI: 10.7759/cureus.10049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Behcet’s disease (BD) classically presents with recurrent oral ulcers, genital ulceration, uveitis and skin manifestations. Middle-aged people are usually affected with the male gender being associated with severe variant of the disease. It can involve any organ system of the body. Although central nervous system and vascular involvement tend to occur less frequently, they are the commonest cause of mortality. We present a case of a 30-year-old man referred with suspicion of cerebral venous sinus thrombosis to our hospital and subsequently diagnosed with BD. The patient developed, despite being on immunosuppression and anticoagulation, extensive arteriovenous thrombi of lower limbs requiring catheter-directed thrombolysis with continuous 24-hour infusion of tissue plasminogen activator for refractory right lower limb venous thrombosis and placement of inferior vena cava filter to prevent pulmonary embolism. Later disease remission was achieved with rituximab.
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Affiliation(s)
- Saeed Arif
- Neurology, Pak Emirates Military Hospital, Rawalpindi, PAK
| | - Shaheer Arif
- Neurology, Pak Emirates Military Hospital, Rawalpindi, PAK
| | | | | | - Abdur Rahim Palwa
- Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi, PAK
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31
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Elmassry M, Del Rio-Pertuz G, El-Nawaa S, Abdelmalek J, Ansari MM. A Fractured Inferior Vena Cava Strut Migrating to the Right Ventricle Without Any Cardiovascular Complaint: A Case Report and Review of Literature. Cureus 2020; 12:e9779. [PMID: 32953297 PMCID: PMC7491686 DOI: 10.7759/cureus.9779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of inferior vena cava filter (IVCF) as one of the last resorts for pulmonary embolism prevention has expanded over the decades. The migration of a broken strut to the right ventricle is a very unusual complication that, when present, has been associated with life-threatening events. We report a case of a 34-year-old female with an inferior vena cava (IVC) strut that migrated and was incidentally found embedded in the right ventricle without any cardiovascular signs or symptoms. This case provides evidence that such filters probably have higher rates of complications than what has been thought because those complications might remain asymptomatic.
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Affiliation(s)
- Mohamed Elmassry
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Saif El-Nawaa
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - John Abdelmalek
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Mohammad M Ansari
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
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32
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Atik FA, da Cunha CR, Macedo MT, Monte GU. Penetrated inferior vena cava filter retrieved by open surgery with deep hypothermic circulatory arrest. J Card Surg 2020; 35:1642-1643. [PMID: 32484974 DOI: 10.1111/jocs.14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Complications of inferior vena cava filters are relatively common, and they vary according to different filter types and designs. We aim to present a case of penetrated inferior vena cava filter into the liver. METHODS Case report. RESULTS A 42-year old man with thrombophilia (prothrombin gene mutation) required the insertion of an inferior vena cava filter because of recurrent gastrointestinal bleeding associated with oral anticoagulation. However, it penetrated through the retro-hepatic vena cava into the liver, being manifested by constant, blunt abdominal pain. Endovascular retrieval was considered of extreme risk, though a surgical approach was performed under cardiopulmonary bypass with deep hypothermic circulatory arrest. The patient has recovered uneventfully with complete symptom relief. CONCLUSIONS In symptomatic penetrated vena cava filters in which endovascular retrieval is not feasible, a surgical approach with appropriate planning is a safe and effective treatment.
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Affiliation(s)
- Fernando A Atik
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil
| | - Claudio R da Cunha
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil
| | - Murilo T Macedo
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil
| | - Guilherme U Monte
- Department of Cardiology, Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil
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Melmed K, Chen ML, Al-Kawaz M, Kirsch HL, Bauerschmidt A, Kamel H. Use and Removal of Inferior Vena Cava Filters in Patients With Acute Brain Injury. Neurohospitalist 2020; 10:188-192. [PMID: 32549942 DOI: 10.1177/1941874420907531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Few data exist regarding the rate of inferior vena cava (IVC) filter retrieval among brain-injured patients. Methods We conducted a retrospective cohort study using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients aged ≥65 years who were hospitalized with acute brain injury. The primary outcome was the retrieval of IVC filter at 12 months and the secondary outcomes were the association with 30-day mortality and 12-month freedom from pulmonary embolism (PE). We used Current Procedural Terminology codes to ascertain filter placement and retrieval and International Classification of Diseases, Ninth Revision, Clinical Modification codes to ascertain venous thromboembolism (VTE) diagnoses. We used standard descriptive statistics to calculate the crude rate of filter placement. We used Cox proportional hazards analysis to examine the association between IVC filter placement and mortality and the occurrence of PE after adjustment for demographics, comorbidities, and mechanical ventilation. We used Kaplan-Meier survival statistics to calculate cumulative rates of retrieval 12 months after filter placement. Results Among 44 641 Medicare beneficiaries, 1068 (2.4%; 95% confidence interval [CI], 2.3%-2.5) received an IVC filter, of whom 452 (42.3%; 95% CI, 39.3%-45.3) had a diagnosis of VTE. After adjusting for demographics, comorbidities, and mechanical ventilation, filter placement was not associated with a reduced risk of mortality (hazard ratio [HR], 1.0; 95% CI, 0.8-1.3) regardless of documented VTE. The occurrence of pulmonary embolism at 12 months was associated with IVC filter placement (HR, 3.19; 95% CI, 1.3-3.3) in the most adjusted model. The cumulative rate of filter retrieval at 12 months was 4.4% (95% CI, 3.1%-6.1%); there was no significant difference in retrieval rates between those with and without VTE. Conclusions In a large cohort of Medicare beneficiaries hospitalized with acute brain injury, IVC filter placement was uncommon, but once placed, very few filters were removed. IVC filter placement was not associated with a reduced risk of mortality and did not prevent future PE.
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Affiliation(s)
- Kara Melmed
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Monica L Chen
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Mais Al-Kawaz
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hannah L Kirsch
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Andrew Bauerschmidt
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.,Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Li W, Yin Y, Gu C, Fan B, Duan P, Jin Y, Ni C. Modified one-session endovascular treatment for deep venous thrombosis with high risk of pulmonary embolism: Short-term outcomes. Phlebology 2020; 35:524-532. [PMID: 32028851 DOI: 10.1177/0268355520904270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. METHOD Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. RESULTS A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%-90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12-25 months of follow-up, iliac vein stents and lower extremity veins maintained patent. CONCLUSIONS The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.
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Affiliation(s)
- Wei Li
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Yin
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengtao Gu
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Baorui Fan
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengfei Duan
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonghai Jin
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Caifang Ni
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
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Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, Blais D, Janicke D, Melamed R, Mohrien K, Rozycki E, Ross CB, Klein AJ, Rali P, Teman NR, Yarboro L, Ichinose E, Sharma AM, Bartos JA, Elder M, Keeling B, Palevsky H, Naydenov S, Sen P, Amoroso N, Rodriguez-Lopez JM, Davis GA, Rosovsky R, Rosenfield K, Kabrhel C, Horowitz J, Giri JS, Tapson V, Channick R. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost 2019; 25:1076029619853037. [PMID: 31185730 PMCID: PMC6714903 DOI: 10.1177/1076029619853037] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.
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Affiliation(s)
| | | | - Kamran Ahrar
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdulah Alrifai
- 4 University of Miami of Palm Beach Regional Campus/JFK Hospital, Atlantis, FL, USA
| | - David M Dudzinski
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Danielle Blais
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Roman Melamed
- 9 Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Elizabeth Rozycki
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Parth Rali
- 10 Temple University, Philadelphia, PA, USA
| | | | | | | | | | | | - Mahir Elder
- 14 Wayne State University, Detroit, MI, USA.,15 Michigan State University, East Lansing, MI, USA
| | | | | | | | | | | | | | | | - Rachel Rosovsky
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth Rosenfield
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Jay S Giri
- 16 University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Tapson
- 21 Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Elias M, Elias A, Oropello J, Doucette J, Jebakumar J, Kohli-Seth R. Outcomes and Prognosis Factors in Patients With Vena Cava Filters in a Quaternary Medical Center: A 5-Year Retrospective Analysis. J Intensive Care Med 2019; 36:277-283. [PMID: 31774029 DOI: 10.1177/0885066619890324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Indications for inferior vena cava filter (IVCF) placement are controversial. This study assesses the proportion of different indications for IVCF placement and the associated 30-day event rates and predictors for all-cause mortality, deep vein thrombosis (DVT), pulmonary embolism, and bleeding after IVCF placement. METHOD In this 5-year retrospective cohort observational study in a quaternary care center, consecutive patients with IVCF placement were identified through cross-matching of 3 database sets and classified into 3 indication groups defined as "standard" in patients with venous thromboembolism (VTE) and contraindication to anticoagulants, "extended" in patients with VTE but no contraindication to anticoagulants, and "prophylactic" in patients without VTE. RESULTS We identified 1248 IVCF placements, that is, 238 (19.1%) IVCF placements for standard indications, 583 (46.7%) IVCF placements for extended indications, and 427 (34.2%) IVCF placements for prophylactic indications. Deep vein thrombosis rates [95% confidence interval] were higher in the extended (8.06% [5.98-10.58]) and prophylactic (7.73% [5.38-10.68]) groups than in the standard group (3.36% [1.46-6.52]). Mortality rates were higher in the standard group (12.18% [8.31-17.03]) than in the extended group (7.55% [5.54-9.99]) and the prophylactic (5.85% [3.82-8.52]) group. Bleeding rates were higher in the standard group (4.62% [2.33-8.12]) than in the prophylactic group (2.11% [0.97-3.96]). Best predictors for VTE were acute medical conditions; best predictors for mortality were age, acute medical conditions, cancer, and Medicare health insurance. CONCLUSIONS Prophylactic and extended indications account for the majority of IVCF placements. The standard indication is associated with the lowest VTE rate that may be explained by the competing risk of mortality higher in this group and related to the underlying medical conditions and bleeding risk. In the prophylactic group (no VTE at baseline), the exceedingly high DVT rate may be related to the IVCF placement.
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Affiliation(s)
- Michael Elias
- Critical Care Medicine, 5317OhioHealth Mansfield Hospital, Mansfield, OH, USA
| | - Antoine Elias
- Division of Cardiology and Vascular Medicine, Toulon Hospital Center, St Musse Hospital, Toulon Cedex, France
| | - John Oropello
- Institute for Critical Care Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Doucette
- Division of Biostatistics, Department of Environmental Medicine and Public Health, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jebakaran Jebakumar
- Department of Clinical Operations, 5864Mount Sinai Health Systems, New York, NY, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ludwig DR, Fraum TJ, White GL, Narra VR. Spontaneous rupture of the inferior vena cava (IVC) in the setting of IVC filter thrombosis: case report. J Radiol Case Rep 2019; 13:19-27. [PMID: 31565174 DOI: 10.3941/jrcr.v13i3.3499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology Washington University School of Medicine Saint Louis, MO, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology Washington University School of Medicine Saint Louis, MO, USA
| | - G Lance White
- Mallinckrodt Institute of Radiology Washington University School of Medicine Saint Louis, MO, USA
| | - Vamsi R Narra
- Mallinckrodt Institute of Radiology Washington University School of Medicine Saint Louis, MO, USA
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Aiping Y, Shuangyin Z, Yanhong X, Rongzhi Z. Management of intraoperative acute pulmonary embolism in a patient with subarachnoid haemorrhage undergoing femoral fracture repair. J Int Med Res 2019; 47:5307-5311. [PMID: 31552755 PMCID: PMC6833381 DOI: 10.1177/0300060519874158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Acute pulmonary embolism (APE) during surgery can be life-threatening. We herein
report a case of a 56-year-old man with subarachnoid haemorrhage who underwent
surgical repair of a femoral fracture. During surgery with the patient under
general anaesthesia, his oxygen saturation and end-tidal carbon dioxide
decreased dramatically. An emergency transoesophageal echocardiogram
demonstrated mobile echogenic densities in the right pulmonary artery and
enlargement of the right atrium, and these findings were suggestive of APE.
Considering the patient’s history of subarachnoid haemorrhage, anticoagulation
with heparin or thrombolysis therapy for APE was contraindicated. We recommended
inferior vena cava filter placement to prevent recurrence of the APE.
Unfortunately, the patient and his family members refused the filter
implantation, and the patient was discharged.
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Affiliation(s)
- Yang Aiping
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhang Shuangyin
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xing Yanhong
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhang Rongzhi
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
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Seifabadi R, Pritchard WF, Leonard S, Bakhutashvili I, Woods DL, Esparza-Trujillo JA, Karanian JW, Wood BJ. Feasibility and Acute Safety Study of Radiofrequency Energy Delivery to the Vena Caval Wall via an IVC Filter in Swine. J Eng Sci Med Diagn Ther 2019; 2:031005-1-031005-7. [PMID: 33134858 PMCID: PMC7595439 DOI: 10.1115/1.4043901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/06/2019] [Indexed: 06/11/2023]
Abstract
Retrievable inferior vena cava (IVC) filters are self-expanding metallic devices implanted in the IVC to prevent migration of thrombi from the deep veins of the legs and pelvis to the lungs. The risk of complications from the filters increases with duration of implantation, but retrieval may be difficult due to intimal hyperplasia around the components of the filter. In this study, the potential for delivery of radiofrequency (RF) energy to the IVC wall via the filter was investigated. IVC filters were deployed in 4 swine while attached to a snare connected to a 480 kHz RF generator. Energy ranging from 0 to 48 kJ was applied via the filter followed by re-sheathing and withdrawal of the filter while connected to a force measurement device. Resheathing forces for the 0-energy cohort and pooled data from the 6-24 kJ cohorts were 4.50±0.70 N and 4.50±0.75 N, respectively. Petechial hemorrhages and variable non-occlusive thrombi were noted in some cohorts including the 0-energy cohort, consistent with delivery and acute retrieval of an IVC filter. Histologically, the extent of RF-induced injury was subtle at 6 kJ with focal areas of homogenized collagen while the 12 kJ cohort showed segmental tissue charring with coagulation necrosis which was more extensive for the 24 kJ cohort. The 48 kJ energy caused more extensive and non-target organ damage. The study demonstrated feasibility of delivery of RF to the IVC wall via a deployed filter, supporting further study of the ability of local RF heating of the IVC wall to inhibit the neointimal hyperplasia or as an aid in retrieval.
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Affiliation(s)
| | | | - Shelby Leonard
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Ivane Bakhutashvili
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - David L. Woods
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Juan A. Esparza-Trujillo
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - John W. Karanian
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Bradford J. Wood
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
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40
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Marrone G, Crinò F, Morsolini M, Caruso S, Miraglia R. Multidisciplinary approach in the management of uterine intravenous leiomyomatosis with intracardiac extension: case report and review of literature. J Radiol Case Rep 2019; 13:1-13. [PMID: 31558962 DOI: 10.3941/jrcr.v13i7.3607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.
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Affiliation(s)
- Gianluca Marrone
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesca Crinò
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Marco Morsolini
- Department of Cardio-Thoracic Surgery, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Settimo Caruso
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Roberto Miraglia
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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Poliwoda S, Suthar R, Suraci N, Garcia P, Behrens V, Goldman H. Inferior vena cava filter removal - Hope for the best and prepare for the worst: An anesthesiology perspective. Ann Card Anaesth 2019; 22:337-339. [PMID: 31274503 PMCID: PMC6639879 DOI: 10.4103/aca.aca_159_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient presented to our institution for an elective removal of an inferior vena cava (IVC) filter under local anesthesia. Once removed, it was noticed that the filter had a missing secondary leg. The patient had a chest CT done which showed a hyper-attenuating structure in the region of the tricuspid valve highly suspicious for the fractured strut of the filter. Upon these findings, the patient was taken once again to the surgical suite for an endovascular retrieval of the strut. For fear of a possible cardiac injury and a potential need for a sternotomy, the patient received general anesthesia and was placed with appropriate IV access and full cardiac monitors. The strut was removed successfully without any complications. Despite the relative benign nature of this endovascular procedure, one should always be prepared for an appropriate resuscitation in case of an occurrence of a surgical complication.
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Affiliation(s)
- Salomon Poliwoda
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Rekhaben Suthar
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Nicholas Suraci
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Pedro Garcia
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Vicente Behrens
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Howard Goldman
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
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42
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Holleck JL, Chen EY, Bonomo J. Caval Perforation from a Malpositioned Inferior Vena Cava Filter. J Gen Intern Med 2019; 34:1358-1359. [PMID: 30972553 PMCID: PMC6614244 DOI: 10.1007/s11606-019-04933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/20/2018] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jürgen L Holleck
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Medicine,, Veterans Affairs Connecticut Healthcare System West Haven Campus, West Haven, CT, USA.
| | - Eric Y Chen
- Yale University School of Medicine, New Haven, CT, USA
| | - Jason Bonomo
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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43
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Abstract
Inferior vena cava (IVC) filters are important devices for patients who are at high risk for developing thrombi and pulmonary embolism but have conditions that preclude the use of pharmacologic anticoagulants. IVC filter retrieval has become an important quality initiative backed by Food and Drug Administration guidelines for prompt removal after the filter is no longer indicated. Filter retrieval is a common procedure that usually has very few complications. However, when the filter is tilted or embedded in the caval wall, advanced techniques of retrieval may be necessary. These techniques have a higher rate of success but also a higher risk of complications such as injury to the IVC. Here, we describe a case of IVC filter retrieval resulting in formation of an arteriovenous fistula between the right renal artery and IVC and subsequent successful repair of this fistula using a vascular plug.
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Affiliation(s)
- Charisma DeSai
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Lamus
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Girish Kumar
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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El Ayech F, Ternacle J, Boudiche S, Gallet R, Boukantar M, Hamon D, Nguyen A, Riant E, Mouillet G, Teiger E, Lellouche N. Percutaneous Left Atrial Appendage Closure in Patients With Inferior Vena Cava Filters: A Case Series. J Invasive Cardiol 2019; 31:128-132. [PMID: 31034435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Percutaneous procedures through femoral access in patients with inferior vena cava (IVC) filter may be at risk of complications. We evaluated the feasibility and safety of left atrial appendage (LAA) closure through femoral access in patients previously implanted with IVC filter. METHODS From November 2011 to March 2018, a total of 5 patients with history of IVC filter implantation were referred to our center for percutaneous LAA closure, representing 3.6% of the 137 procedures performed during the study period. The IVC filter devices were placed from 2 to 26 months before the index procedure. RESULTS LAA closure was successfully implanted in all cases using an Amulet device in 3 patients and a Watchman device in 2 patients. A femoral approach was performed in all patients using 12 or 14 Fr sheaths. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or late complications related to the procedure occurred after 10.1 ± 3.9 months of follow-up. CONCLUSION LAA closure in patients with previously implanted IVC filter is safe as long as careful x-ray monitoring is observed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nicolas Lellouche
- Service de Cardiologie Hôpital Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France.
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45
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Shin BJ, Habibollahi P, Zafar H, Hilton S, Stavropoulos SW, Trerotola SO. Reporting of Inferior Vena Cava Filter Complications on CT: Impact of Standardized Macros. AJR Am J Roentgenol 2018; 211:439-44. [PMID: 29873505 DOI: 10.2214/AJR.17.19148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to report the effect of implementing standardized inferior vena cava filter (IVCF) macros on the reporting of IVCFs and filter-related complications in abdominal CT reports. MATERIALS AND METHODS Retrospective analysis was performed of all abdominal CT reports performed between October 2014 and January 2015 before implementation of IVCF macros (n = 5143). Duplicated examinations and studies requested specifically to evaluate known IVCFs were excluded. In March 2016, normal and abnormal standardized IVCF macros were implemented. Two radiologists reviewed all CT abdominal reports using IVCF macros between March 2016 to July 2016 to assess for missed IVCF complications. RESULTS Before the implementation of the IVCF macros, 146 of 5143 (2.8%) abdominal CT studies (89 men and 57 women; mean age, 59 years) showed an IVCF. After implementation of IVCF macros, 105 abdominal CT studies using the IVCF macros were analyzed (48 men and 57 women; mean age, 58 years), including 73 normal macros and 32 abnormal macros). The rate of reported caval penetration and filter element-organ interaction improved from 12% (9/73) to 57% (28/49) (p < 0.001) and from 0% (0/53) to 36% (9/25) (p < 0.001) before and after macro implementation, respectively. However, one filter fracture and two filter-associated thrombi were missed when using the IVCF macros. CONCLUSION Implementation of standardized IVCF macros improves reporting of IVCFs and IVCF-associated complications in abdominal CT reports.
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Chen JX, Montgomery J, McLennan G, Stavropoulos SW. Endobronchial Forceps-Assisted and Excimer Laser-Assisted Inferior Vena Cava Filter Removal: The Data, Where We Are, and How It Is Done. Tech Vasc Interv Radiol 2018; 21:85-91. [PMID: 29784126 DOI: 10.1053/j.tvir.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The recognition of inferior vena cava filter related complications has motivated increased attentiveness in clinical follow-up of patients with inferior vena cava filters and has led to development of multiple approaches for retrieving filters that are challenging or impossible to remove using conventional techniques. Endobronchial forceps and excimer lasers are tools for designed to aid in complex inferior vena cava filter removals. This article discusses endobronchial forceps-assisted and excimer laser-assisted inferior vena cava filter retrievals.
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Affiliation(s)
- James X Chen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jennifer Montgomery
- Department of Interventional Radiology and Bioengineering, Cleveland Clinic, Cleveland, OH
| | - Gordon McLennan
- Department of Interventional Radiology and Bioengineering, Cleveland Clinic, Cleveland, OH
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47
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Shabib AB, Alsayed F, Aldughaythir S, Habeeb H, Al Tamimi S, Masuadi E, Alzahrani M, Alaklabi A, Alotaibi A, Rajendram R, Almegren M. Indications, retrieval rate, and complications of inferior vena cava filters: Single-center experience in Saudi Arabia. Ann Thorac Med 2018; 13:108-113. [PMID: 29675062 PMCID: PMC5892085 DOI: 10.4103/atm.atm_356_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Inferior vena cava (IVC) filter is indicated in patients with acute venous thromboembolism (VTE) in whom therapeutic anticoagulation is contraindicated. While prophylactic insertion of an IVC filter may be considered for patients at high risk of VTE, there are significant differences between clinical guidelines on the role of IVC filters. These discrepancies have arisen predominantly because of the paucity of data on the efficacy and safety of IVC filters. We, therefore, evaluated the indications for filter insertion, the rate of filter retrieval and complications in patients who received IVC filters at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. METHODS: A descriptive, retrospective review of electronic- and paper-based medical records was performed. Consecutive sampling was used to study all adult patients who received an IVC filter at KAMC between 2007 and 2016 and met the inclusion criteria. RESULTS: A total of 382 IVC filters were inserted. 113 patients (30%) had an acute VTE and a contraindication to anticoagulation while 53 patients (14%) received an IVC filter in the absence of VTE (i.e., prophylactic). Only 124 (32.5%) IVC filters were eventually retrieved. The most common reason for nonretrieval was the need for permanent filtration (155, 60%). Thrombotic complications developed in 72 (19%) patients; nine patients had fatal pulmonary embolism. CONCLUSION: The insertion of IVC filters in this cohort was associated with low retrieval rate and relatively high incidence of thrombotic complications. Follow-up of patients is required to detect IVC filter-related complications and to increase retrieval rate.
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Affiliation(s)
- Abdullah Bin Shabib
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad Alsayed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saad Aldughaythir
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hanan Habeeb
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sumayyah Al Tamimi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Emad Masuadi
- Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Oncology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
| | - Ali Alaklabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Azzam Alotaibi
- Department of Medicine, College of Medicine, Al Imam Mohammad IBN Saud Islamic University, Riyadh, Saudi Arabia
| | - Rajkumar Rajendram
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mosaad Almegren
- Department of Medicine, College of Medicine, Al Imam Mohammad IBN Saud Islamic University, Riyadh, Saudi Arabia
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Rottenstreich A, Kalish Y, Elchalal U, Klimov A, Bloom AI. Retrievable inferior vena cava filter utilization in obstetric patients. J Matern Fetal Neonatal Med 2018; 32:3045-3053. [PMID: 29562788 DOI: 10.1080/14767058.2018.1456521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives: The objective of this study is to evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients. Methods: A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005-2016. A pooled analysis of the relevant cases in the English literature was conducted. Results: The current cohort comprised 24 women, median age 27 [interquartile range 24-30] years. Among 10 filters placed during pregnancy, the most common indication (n = 4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis. In the postpartum period, most filters (64%, 9/14) were an adjunct to catheter-directed thrombolytic therapy. Inferior vena cava filters (IVCF)-related complications occurred in seven (29.2%). Retrieval was attempted in 21 patients (87.5%), and was technically successful in 19 (90.5%), for an overall removal rate of 79.1%. Pooled analysis of the literature (n = 98) showed comparable rates for filter removal and complications (81.6%, p = .78 and 24.2%, p = .60, respectively). Suprarenal placement (p = .12) and elective cesarean section (p = .19) did not reduce overall complication and retrieval rates. The estimated radiation dose among pregnant patients who underwent rIVCF placement without adjunct catheter directed thrombolysis (CDT) (mean 695 Gy cm2) was significantly lower than the radiation dose used in postpartum patients (1863 Gy cm2) or in pregnant patients in whom adjunct CDT was utilized (4059 Gy cm2) (p = .001 for both comparisons). Conclusions: Frequent rIVCF-related complications, radiation exposure, and removal failure call for their cautious utilization in obstetric patients. The role of suprarenal placement and elective cesarean section to improve outcomes has yet to be established.
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Affiliation(s)
- Amihai Rottenstreich
- a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Yosef Kalish
- b Department of Hematology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Uriel Elchalal
- a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Alexander Klimov
- c Department of Radiology , Interventional Radiology Section, Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Allan I Bloom
- c Department of Radiology , Interventional Radiology Section, Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Hara N, Miyamoto T, Yamaguchi J, Iwai T, Hijikata S, Watanabe K, Sagawa Y, Masuda R, Miyazaki R, Miwa N, Sekigawa M, Yamaguchi T, Nagata Y, Nozato T, Kobayashi O, Umezawa S, Obayashi T. Treatment Outcomes of Anticoagulant Therapy and Temporary Inferior Vena Cava Filter Implantation for Pregnancy Complicated by Venous Thrombosis. Ann Vasc Dis 2018; 11:106-111. [PMID: 29682116 PMCID: PMC5882350 DOI: 10.3400/avd.oa.17-00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Although deep vein thrombosis (DVT) followed by pulmonary thromboembolism (PE) is a critical complication during pregnancy, there have been few reports about its intrapartum management. We evaluated intrapartum management by using a temporary inferior vena cava filter (IVCF) in pregnant women with PE/DVT. Materials and Methods: Eleven women with PE/DVT during pregnancy between January 2004 and December 2016 were included. The patients were hospitalized for intravenous unfractionated heparin infusion after acute PE/DVT onset. Seven patients were discharged and continued treatment with subcutaneous injection of heparin at the outpatient unit. IVCF was implanted 1–3 days before delivery in 10 patients. Anticoagulant therapy was discontinued 6–12 h before delivery. We retrospectively analyzed rates of maternal or perinatal death, and recurrence of symptomatic PE/DVT. Results: One patient was diagnosed as having PE/DVT and 10 had DVT alone. One patient suffered hemorrhagic shock during delivery; however, maternal or perinatal death and recurrence of symptomatic PE/DVT did not occur in any patient. Conclusion: Maternal or perinatal death and recurrence of symptomatic PE/DVT was not seen in women diagnosed as having PE/DVT during pregnancy and treated with anticoagulant therapy and IVCF.
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Affiliation(s)
- Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takamichi Miyamoto
- Department of General Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Junji Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takamasa Iwai
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Sadahiro Hijikata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryo Masuda
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Naoyuki Miwa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiro Sekigawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Orie Kobayashi
- Department of Gynecology and Obstetrics, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Satoshi Umezawa
- Department of Gynecology and Obstetrics, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toru Obayashi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.,Department of Clinical Engineering, Gunma Paz College, Gunma, Japan
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Gohbara M, Hayakawa K, Hayakawa A, Akazawa Y, Yamaguchi Y, Furihata S, Kondo A, Fukushima Y, Tomari S, Mitsuhashi T, Endo T, Kimura K. Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism. Intern Med 2018; 57:647-654. [PMID: 29151532 PMCID: PMC5874334 DOI: 10.2169/internalmedicine.9473-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective The admission glucose level is a predictor of mortality even in patients with acute pulmonary embolism (APE). However, whether or not the admission glucose level is associated with the severity of APE itself or the underlying disease of APE is unclear. Methods This study was a retrospective observational study. A pulmonary artery (PA) catheter was used to accurately evaluate the severity of APE. The percentage changes in the mean PA pressure (PAPm) upon placement and removal of the inferior vena cava filter (IVCF) were evaluated. We hypothesized that the admission glucose level was associated with the improvement in the PA pressure in patients with APE. Patients A total of consecutive 22 patients with submassive APE who underwent temporary or retrievable IVCF insertion on admission and repetitive PA catheter measurements upon placement and removal of IVCFs were enrolled. Results There was a significant positive correlation between the admission glucose levels and the percentage changes in the PAPm (r=0.543, p=0.009). A univariate linear regression analysis showed that the admission glucose level was the predictor of the percentage change in PAPm (β coefficient=0.169 per 1 mg/dL; 95% confidence interval, 0.047-0.291; p=0.009). A multivariate linear regression analysis with the forced inclusion model showed that the admission glucose level was the predictor of the percentage change in PAPm independent of diabetes mellitus, PAPm on admission, troponin positivity, and brain natriuretic peptide level (all p<0.05). Conclusion The admission glucose level was associated with the improvement in the PAPm in patients with submassive-type APE.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Keigo Hayakawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Azusa Hayakawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | | | - Shuta Furihata
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Ai Kondo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Yusuke Fukushima
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Sakie Tomari
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | | | - Tsutomu Endo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan
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