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Lu Z, Song J, He Y, Huang G, Fu S, Zhang Q, Yu J, Gao Q. A severe complication of J-tip guide wire during catheterization: A case report and discussion. Semin Dial 2023; 36:267-269. [PMID: 36790848 DOI: 10.1111/sdi.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
J-tip guide wire entrapment within the heart is a serious and dangerous complication that is rarely mentioned. We present a case in which the J-tip guide wire was entrapped in the right atrium during tunneled cuffed venous catheterization. We were unable to remove the guide wire using previously reported methods and concluded with surgery. Owing to the special structure of the guide wire itself, a safe removal process needs to be discussed. Patient consent for publication was obtained prior to the submission of the manuscript.
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Affiliation(s)
- Zhihong Lu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Junfeng Song
- Department of Pediatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongchun He
- Kidney Disease Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Guoping Huang
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Songling Fu
- Department of Cardiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Qing Zhang
- Department of Cardiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Jiangen Yu
- Department of Cardiothoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Qiang Gao
- Department of Cardiothoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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Vassallo F, Santos L, Walker BR, França R, Madeira C, Mauro V, César F, Corcino L, Serpa R. Successful Left Atrial Appendage Closure with Watchman Device Implantation in Two Patients with Inferior Vena Cava Filters. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i3.3454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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 closure (LAAC) through femoral access in patients previously implanted with IVC filter. We described the WatchmanTM device implantation in two patients with formal contraindication for oral anticoagulation. First patient had a GreenfieldTM filter and the second one an OpteaseTM filter, and in this patient an attempt to withdrawal the filter immediately before the LAAC procedure failed. A femoral approach was performed in both patients using a 14 Fr sheath. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or intrahospital complications related to the procedure occurred. Herein, we presented two cases of successful LAAC closure with Watchman device in patients with two different kinds of IVC filters.
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3
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Jo S, Kang HM, Kim SK, Lee JW, Chung NG, Cho B, Jeong DC, Park YJ. Source Identification of Klebsiella pneumoniae Causing Six Episodes of Recurrent Sepsis in an Adolescent That Underwent Hematopoietic Stem Cell Transplantation. Pathogens 2021; 10:pathogens10091123. [PMID: 34578155 PMCID: PMC8468436 DOI: 10.3390/pathogens10091123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Septicemia or bacteremia is one of the leading causes of death worldwide. Long-term tunneled central venous catheters (CVCs) are usually placed in children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) for underlying hemato–oncologic malignancies. However, catheter-related complications have been reported frequently, and there is high morbidity and mortality related to catheter-line-associated bloodstream infections (CLABSIs). We report a rare case of six episodes of recurrent K. pneumoniae sepsis within a 6-month period in a 12-year-old male adolescent that underwent HSCT for acute lymphoblastic leukemia, despite treatment with susceptible antibiotics. The patient received extensive diagnostic evaluations to find the hidden source; however, failure to discover the primary source led to multiple recurrences. Through enterobacterial repetitive intergenic consensus (ERIC)-PCR, we were able to identify the relationship between the six episodes and recognize the source of bacteremia.
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Affiliation(s)
- Suejung Jo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
- Correspondence: ; Tel.: +82-2-2258-6273; Fax: +82-2-537-4544
| | - Seong Koo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
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4
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus 2019; 11:e4717. [PMID: 31355077 PMCID: PMC6650175 DOI: 10.7759/cureus.4717] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of a central line or central venous catheterization was brought to attention in 1929 when Dr. Werner Forssmann self-inserted a ureteric catheter through his cubital vein and into the right side of his heart. Since that time the central line technique has developed further and has become essential for the treatment of decompensating patients. Central lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. The following review article addresses these parameters of central lines and goes into detail regarding their complications.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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5
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Kashif M, Hashmi H, Jadhav P, Khaja M. A Missing Guide Wire After Placement of Peripherally Inserted Central Venous Catheter. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:925-928. [PMID: 27920421 PMCID: PMC5142581 DOI: 10.12659/ajcr.901046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit. CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration. A bedside ultrasound performed by the intensivist to evaluate upper extremity swelling revealed a foreign body in the left arm. Percutaneous procedure by Interventional radiologist was required for retrieval of the guidewire. CONCLUSIONS Guide wire related complications are rarely reported, but are significantly associated with mortality and morbidity. The use of ultrasound guidance placement of PICC lines decreases the risk of complications, provides better optimal vein selection, and enhances success.
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Affiliation(s)
- Muhammad Kashif
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Hafiz Hashmi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Preeti Jadhav
- Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Abstract
Venous thromboembolism (VTE) is a common complication among patients in the intensive care unit. While anticoagulation remains standard therapy, vena caval filters are an important alternative when anticoagulation is contraindicated. To determine the safety and efficacy of vena caval filters in the treatment of VTE, a comprehensive review of the English-language medical literature was performed. Except for one randomized controlled trial, the literature supporting the use of vena caval filters consists almost exclusively of case series, which in many instances are limited by incomplete and short follow-up. While case series suggest that filters function effectively in the prevention of pulmonary embolism (2%-4% symptomatic pulmonary embolism [PE], fatal PE < 2%), recent higher quality studies indicate that filters may not provide significant additional protection to that provided by anticoagulation alone. Furthermore, filters are associated with a 2- fold increase in the incidence of recurrent DVT. Until randomized comparative studies are available, the safety and efficacy of all the available devices should be considered to be roughly equivalent. Since filters do not inhibit continued clot formation, all filter patients should receive anticoagulation for durations appropriate for their thrombotic disorder. Although extended anticoagulation may prevent thrombotic complications associated with filter placement, this strategy has yet to be experimentally tested. While many additional indications for vena caval filter use have been proposed (VTE in cancer patients, PE prophylaxis in trauma patients, etc), well-designed clinical trials demonstrating their efficacy in these situations are lacking. Further development of temporary/retrievable filters, which offer the potential to avoid the long-term complications of permanent filters, should be a research priority. Until additional data are available, vena caval filters should generally be restricted to patients with VTE who cannot receive anticoagulation.
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Affiliation(s)
- Michael B Streiff
- Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Ross Research Building, Room 1025, 720 Rutland Avenue, Baltimore, MD 21205, USA
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7
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Abstract
Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications.
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Affiliation(s)
- Craig Kornbau
- Department of Surgery, Summa Akron City Hospital, Akron, Ohio, United States
| | - Kathryn C Lee
- Division of Critical Care Medicine, Summa Akron City Hospital, Akron, Ohio, United States
| | - Gwendolyn D Hughes
- Division of Critical Care Medicine, Summa Akron City Hospital, Akron, Ohio, United States
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8
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Kale SB, Raghavan J. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection. Indian J Anaesth 2013; 57:390-3. [PMID: 24163455 PMCID: PMC3800333 DOI: 10.4103/0019-5049.118564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.
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Affiliation(s)
- Suresh Babu Kale
- Department of Cardiothoracic Surgery, Institute for Cardiac Treatment and Research, Southern Railway Headquarter Hospital, Perambur, Chennai, Tamil Nadu, India
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9
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Strategies for prevention of iatrogenic inferior vena cava filter entrapment and dislodgement during central venous catheter placement. J Vasc Surg 2013; 59:255-9. [PMID: 24080132 DOI: 10.1016/j.jvs.2013.07.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Iatrogenic migration of inferior vena cava (IVC) filters is a potentially life-threatening complication that can arise during blind insertion of central venous catheters when the guide wire becomes entangled with the filter. In this study, we reviewed the occurrence of iatrogenic migration of IVC filters in the literature and assessed methods for preventing this complication. METHODS A literature search was conducted to identify reports of filter/wire entrapment and subsequent IVC filter migration. Clinical outcomes and complications were identified. RESULTS A total of 38 cases of filter/wire entrapment were identified. All of these cases involved J-tip guide wires. Filters included 23 Greenfield filters, 14 VenaTech filters, and one TrapEase filter. In 18 cases of filter/wire entrapment, there was migration of the filter to the heart and other central venous structures. Retrieval of the migrated filter was successful in only four of the 18 cases, and all of these cases were complicated by strut fracture and distant embolization of fragments. One patient required resuscitation during retrieval. Successful disengagement was possible in 20 cases without filter migration. CONCLUSIONS Iatrogenic migration of an IVC filter is an uncommon complication related to wire/filter entrapment. This complication can be prevented with knowledge of the patient's history, use of proper techniques when placing a central venous catheter, identification of wire entrapment at an early stage, and use of an appropriate technique to disengage an entrapped wire.
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10
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Rajasekhar A, Streiff MB. Vena cava filters for management of venous thromboembolism: A clinical review. Blood Rev 2013; 27:225-41. [DOI: 10.1016/j.blre.2013.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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11
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Abdel-Aal AK, Saddekni S, Hamed MF. Guide wire entrapment in a vena cava filter: techniques for dislodgement. Vasc Endovascular Surg 2012; 47:115-23. [PMID: 23275482 DOI: 10.1177/1538574412471209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of IVC filters, this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. In this article, we review the various preferred techniques reported in the literature for removal of the entrapped guide wire in particular situations, along with their indications, advantages, and disadvantages. We present simple useful recommendations to prevent this complication.
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Affiliation(s)
- Ahmed K Abdel-Aal
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
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12
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Wu PH, Kuo MC, Li HH, Chen HC. A complication of double lumen hemocatheter guide wire entrapment in a hemodialysis patient. Hemodial Int 2012; 17:307-9. [PMID: 22574944 DOI: 10.1111/j.1542-4758.2012.00705.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Double lumen hemocatheter is commonly used for temporary hemodialysis patient and various complications have been documented but few reports of guide wire-related complications. We report a complication of double lumen hemocatheter guide wire entrapment in a 43-year-old female of type 1 diabetes mellitus and hemodialysis patient. She was admitted for left arteriovenous shunt dysfunction and right internal jugular vein hemocatheter chamber clotting was found while on hemodialysis, so a new hemocatheter was changed over guide wire. Guide wire was introduced without any resistance and the clotting hemocatheter was removed. During the procedure, the J-tipped guide wire could not be withdrawn and portable chest radiography revealed the J-tip of the guide wire was in the right ventricle near the region of tricuspid valve. Fluoroscopy was arranged and it also confirmed the J-tip was lying in the ventricle near the tricuspid valve where it was stuck. Snare catheter kit was inserted through the 10 Fr sheath and the cardiologist untied the knot by endovascular snare and removed the guide wire smoothly. This report emphasizes the importance of awareness on guide wire entrapment while inserting double lumen hemocatheter. When a guide wire became hard to withdraw, extracting an entrapped guide wire with fluoroscopy guide and snare catheter is a preferable and minimal invasive approach.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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13
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Abdel-Aal AK, Saddekni S, Hamed MF, Fitzpatrick F. Entrapment of Guide Wire in an Inferior Vena Cava Filter: A Technique for Removal. Cardiovasc Intervent Radiol 2012; 36:558-60. [DOI: 10.1007/s00270-012-0374-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 03/08/2012] [Indexed: 11/29/2022]
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Affiliation(s)
- Sarika Katiyar
- Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal - 462 038, India
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15
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Owens CA, Bui JT, Knuttinen MG, Gaba RC, Carrillo TC. Pulmonary embolism from upper extremity deep vein thrombosis and the role of superior vena cava filters: a review of the literature. J Vasc Interv Radiol 2010; 21:779-87. [PMID: 20434365 DOI: 10.1016/j.jvir.2010.02.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 02/17/2010] [Accepted: 02/25/2010] [Indexed: 12/16/2022] Open
Abstract
The placement of superior vena cava (SVC) filters to prevent pulmonary emboli (PE) from upper-extremity deep vein thrombosis (UEDVT), although controversial, has been reported. A total of 21 publications were identified that reported 209 SVC filters and documented eight major filter-related complications (3.8%), including four cardiac tamponades, two aortic perforations, and one recurrent pneumothorax. The in-hospital or 1-month mortality rate was 43.1%. Twenty-eight additional publications were identified that reported 3,747 cases of UEDVT. The rates of PE and associated mortality were 5.6% and 0.7%, respectively. Studies imaging both upper and lower extremities found deep vein thrombus 14.7 times more likely to occur in the lower extremities and the rate of PE from a lower-extremity thrombus to be 25.1%. The lack of evidence documenting the risk from UEDVT and the absence of data supporting the safety and efficacy of SVC filters bring their benefit into question.
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Affiliation(s)
- Charles A Owens
- Division of Interventional Radiology, University of Illinois Medical Center, M/C 931, 1740 West Taylor Street, Chicago, IL 60612, USA.
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16
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Chakraborty A, Donoo FA, Roy Chowdhury S, Saha A, Ganguly S, Rupert E. Guidewire entrapment in a tricuspid valve apparatus. J Cardiothorac Vasc Anesth 2009; 24:898-9. [PMID: 20036155 DOI: 10.1053/j.jvca.2009.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Indexed: 11/11/2022]
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17
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Usoh F, Hingorani A, Ascher E, Shiferson A, Tran V, Marks N, Jacob T. Long-term follow-up for superior vena cava filter placement. Ann Vasc Surg 2008; 23:350-4. [PMID: 18809292 DOI: 10.1016/j.avsg.2008.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 06/25/2008] [Accepted: 08/11/2008] [Indexed: 11/25/2022]
Abstract
The short-term effectiveness and safety placement of superior vena cava (SVC) filter in the treatment of upper extremity deep venous thrombosis in patients with contraindication to anticoagulation have been well documented. However, as opposed to the numerous reported experiences with inferior vena cava filter placement and its complications, there has been no documented long-term follow-up on SVC filter placement. We, therefore, reviewed our experience with SVC filter placement. A retrospective review was performed of the 154 cases of patients who underwent SVC filter placement between January 1994 and August 2005 at our institution. Seven additional patients had unsuccessful SVC filter placement due to widespread deep venous thrombosis. The data were evaluated for both insertion complications (pneumothorax, hemorrhage, filter misplacement) and long-term complications (pulmonary embolism, migration, caval occlusion). The follow-up included review of serial chest radiographs to evaluate for filter migration in patients who lived at least 60 days after filter insertion and had chest radiography performed (n = 40), patients' charts, clinic visits, and telephone contacts, hospital databases, city death records, and national databases. There were 69 males and 85 females with a mean age of 73.6 years (range, 16-96 years; +/-15.3 [SD] years). Follow-up ranged from 1 day to 3750 days (256.3 +/- 576 days [mean +/- SD]) and 5 patients were lost to follow-up. Of the 154 patients, 58 survived longer than 60 days with mean follow-up of 628.4 days. All SVC filters (TrapEase, n = 38; Greenfield, n = 116) were successfully deployed in the 154 patients. During the follow-up, 114 (74.0% mortality) of the patients died of chronic illness or from cancer complications. There were three cases of pericardial tamponade (1.9%), and one case of misplaced filter in innominate vein. There were no known cases of symptomatic pulmonary embolism, caval occlusion, pneumothorax, or filter migration. SVC filter placement is associated with a low incidence of complications with long-term follow-up. These data help to reaffirm the safety and effectiveness of SVC filter placement. However, SVC perforation in young males remains a significant issue.
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Affiliation(s)
- Fred Usoh
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA
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18
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Carter LI, Cavendish JJ. Percutaneous closure of a patent foramen ovale via left axillary vein approach with the Amplatzer Cribriform septal occluder. J Interv Cardiol 2008; 21:28-31. [PMID: 18254787 DOI: 10.1111/j.1540-8183.2007.00313.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Percutaneous closure of a patent foramen ovale (PFO) was successfully performed via the left axillary vein in a 52-year-old female with a history of left posterior cerebral artery embolic cerebrovascular accident (CVA) and inferior vena cava (IVC) interruption with a Simon Nitinol Filter precluding standard access via the common femoral vein. Utilizing a 6 French Amplatzer 180 degrees patent ductus arteriosus delivery sheath and a 25-mm Amplatzer Cribriform occluder, the PFO was successfully closed utilizing general anesthesia and transesophageal echocardiography guidance. This case demonstrates the advantages of the axillary vein approach over the internal jugular or hepatic vein approach in patients with anatomy precluding standard percutaneous closure.
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Affiliation(s)
- Luther I Carter
- Cardiology Department, Naval Medical Center San Diego, San Diego, California 92134, USA.
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19
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Haut ER, Kamal MK, Reilly PM, Stavropoulos SW. Successful percutaneous retrieval of a swan-ganz catheter entrapped in an inferior vena cava filter. ACTA ACUST UNITED AC 2007; 62:1507-10. [PMID: 17563676 DOI: 10.1097/01.ta.0000235241.10599.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elliott R Haut
- Division of Trauma and Surgical Critical Care, Department of Surgery, The Johns Hopkins Medical Institution, Baltimore, Maryland 21287, USA.
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20
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Schoeffler M, Ringewald J, Schechter E. Transfemoral venous access through inferior vena cava filters for interventions requiring large sheaths. Catheter Cardiovasc Interv 2006; 69:47-51. [PMID: 17139628 DOI: 10.1002/ccd.20933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The presence of a filter in the inferior vena cava (IVC) to prevent pulmonary embolism from lower extremity deep vein thrombosis has traditionally been a contraindication for venous catheterization from the femoral vein. Certain interventional procedures require femoral access and occasionally, patients with IVC filters require these procedures. The authors report two such patients, one with a Greenfield filter requiring balloon mitral valvuloplasty and one with a Trapease filter requiring atrial septostomy. These cases demonstrate the technical feasibility of interventions across vena cava filters. Based on this experience and a review of the literature we describe in detail the techniques that allowed the procedures to be performed safely and successfully.
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Affiliation(s)
- Michael Schoeffler
- University of Oklahoma Health Sciences Center and OU Medical Center, Oklahoma City, OK 73104, USA
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Rosen MJ, Burns JM, Cobb WS, Jacobs DG, Heniford BT, Sing RF. Guide Wire Entrapment by Inferior Vena Cava Filters: An Experimental Study. J Am Coll Surg 2005; 201:386-90. [PMID: 16125071 DOI: 10.1016/j.jamcollsurg.2005.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Revised: 04/19/2005] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In situ vena cava filters are at risk for complications with the use of J-tipped guide wires. The purpose of this study was to evaluate the impact of two commonly used J-tipped guide wires on the stability of the four most recently released vena cava filters in an in vitro flow model. STUDY DESIGN Four filters (OptEase [F1], Günther Tulip [F2], Vena Tech LP [F3], and Recovery [F4]) were inserted into an in vitro flow model. Two J-tipped guide wires (0.032-inch [GW-1], 0.035-inch [GW-2]) were passed through each filter (n = 50 passes per wire) for a distance of 10 cm. The inserter was blind as to the effects of the wire. The filters were monitored by an independent observer for adverse events occurring between the filters and the guide wires. These were defined as: migrations (>1 cm), change of position (tilt>10 degrees), and entrapment of the wire (unable to remove wire). Descriptive statistics, chi-square, and Fisher's exact test were used (p < 0.05 considered significant). RESULTS GW-1 resulted in a lower incidence of entrapment, migration, and tilt for all filters compared with GW-2 (F1, p = 0.003; F2, p < 0.0001; F3, p < 0.0001; F4, p = 0.0004). GW-1 resulted in entrapment in 0%, migration in 7.5%, and tilt in 10.5% of insertions. GW-2 resulted in entrapment in 1%, migration in 26.5%, and tilt in 5.5% of insertions. The incidence of adverse events for GW-1 was significantly different compared with all filters (F1, 0%; F2, 46%; F3, 4%; and F4, 22%; p < 0.0001). Similarly, the incidence of adverse events for GW-2 was significantly different when evaluating all filters (F1, 12%; F2, 48%; F3, 22%; F4 60%; p < 0.0001). CONCLUSIONS The smaller-diameter guide wire resulted in a decreased incidence of adverse events for all filters, but there is still risk for complications. Knowledge of potential complications associated with vena cava filters and the postinsertion use of guide wires are essential to avoid potential mishaps.
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Affiliation(s)
- Michael J Rosen
- Department of General Surgery, Carolinas Laparoscopic and Advanced Surgical Program, Carolinas Medical Center, Charlotte, NC, USA
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Henrikson CA, Brinker JA. Extraction of a Defibrillator Lead Through an Inferior Vena Cava Filter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1568-70. [PMID: 15546316 DOI: 10.1111/j.1540-8159.2004.00679.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report an extraction of a chronic, previously cut and abandoned, active-fixation implantable cardioverter-defibrillator lead through an inferior vena cava filter. A long workstation sheath that crossed the filter was used, allowing the lead and all hardware to be withdrawn through a single opening in the filter.
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Affiliation(s)
- Charles A Henrikson
- From the Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Affiliation(s)
- Kenneth D Murphy
- Upstate Medical University, State University of New York, Department of Radiology, 750 East Adams Street, Syracuse, NY 13210, USA
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Stavropoulos SW, Itkin M, Trerotola SO. In vitro study of guide wire entrapment in currently available inferior vena cava filters. J Vasc Interv Radiol 2003; 14:905-10. [PMID: 12847198 DOI: 10.1097/01.rvi.0000082827.75926.10] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Guide wire entrapment by some older inferior vena cava (IVC) filters is known to occur, particularly with J-tipped wires. Three new IVC filters have recently been approved for use in the United States. An in vitro study was performed to compare the risk of engaging and entrapping guide wires in eight of the IVC filters currently available in the United States. MATERIALS AND METHODS Titanium Greenfield, over-the-wire stainless-steel Greenfield, Simon nitinol, Bird's Nest, Vena Tech LGM, Vena Tech LP, TrapEase, and Günther Tulip IVC filters were deployed separately in an in vitro IVC flow model. Four different wires (15-mm, 3-mm, and 1.5-mm J-tipped, and straight) were passed 100 times each through the filters (50 from a jugular approach and 50 from a femoral approach). The frequency and specific patterns of engagement of the wires by the filters were recorded. Engagement was defined as a filter/wire interaction that caused either the filter or the wire to be deformed. The second part of the experiment measured the force (in pounds) that was required to release wires that became engaged in the filters with use of an electromechanical test stand with a specially designed low-capacity load cell of 20 pounds. Entrapment was defined as inability to separate an engaged wire from the filter without damage to either the wire or filter. RESULTS Guide wire engagement occurred in all filters tested with the 15-mm, 3-mm, and 1.5-mm J-tipped wires. The straight wire did not engage any of the filters. The wires engaged the TrapEase filter with the greatest frequency overall (72.8%; 291 of 400). The 15-mm J wire engaged the filters more often than the other wires (98.5%; 788 of 800), but never became entrapped in a filter. The Vena Tech LP and Günther Tulip filters did not entrap any of the wires. The TrapEase filter, the stainless-steel Greenfield filter, and the Vena Tech LGM filter entrapped the 3-mm and 1.5-mm J wires. The force required to disengage the wires from these filters exceeded 4 pounds and resulted in structural damage to the wire and/or filter. CONCLUSIONS Among the IVC filters recently approved by the Food and Drug Administration, the TrapEase filter entrapped 3-mm and 1.5-mm J-tipped guide wires, whereas the Vena Tech LP and Günther Tulip filters did not. This study corroborates previously described wire entrapment by the stainless-steel Greenfield and Vena Tech LGM devices.
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Affiliation(s)
- S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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Rufener JB, Andrews RT, Pfister ME, Hofmann LV, Bloch RD, Kudryk BT, Venbrux AC. An evaluation of commonly employed central venous catheter kits and their potential risk for complications of excess guidewire introduction. J Clin Anesth 2003; 15:250-6. [PMID: 12888159 DOI: 10.1016/s0952-8180(03)00060-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To evaluate the components of commonly used central venous catheter kits with respect to the potential for guidewire-mediated complications during catheter placement.Prospective, nonrandomized, observational study. SETTING Six academic hospitals across the United States. PATIENTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS 30 commercially manufactured catheter kits (15 tunneled, 15 nontunneled) were opened and evaluated. The catheter or sheath to be introduced was measured and a corresponding ideal guidewire length was calculated. The ideal length was then compared to the actual length, and differences were tabulated. Wire tip configuration and the presence and pattern of distance markings were recorded and, in conjunction with the catheter and wire length discrepancies, were used to grade the relative risk of introducing excess guidewire during catheter placement. Of 30 kits evaluated, 14 (46.7%) had guidewires more than 20 cm longer than necessary. The mean excess wire length was 15 cm (range: 8 to 55 cm) and did not differ significantly between tunneled and nontunneled catheter kits. Only 10 kits (33.3%) had distance markings of any type, and there was no standardization among them; none corresponded to previously published recommendations. There was potential risk of excess wire introduction in 18 catheter kits, of which seven were nontunneled devices designed for bedside placement. CONCLUSIONS The design of commonly employed central venous access catheter kits is such that there is a mismatch between guidewire and catheter length and a general lack of guidewire markings. We believe that these designs may predispose to the introduction of excess guidewire and result in guidewire-mediated complications during catheter placement. This risk can likely be reduced by matching the guidewires to the devices placed over them and by standardizing guidewire distance markings.
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Affiliation(s)
- Justin B Rufener
- Dotter Interventional Institute, Oregon Health & Science University, Portland, USA
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Murphy KD. SVC Filters. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Munir MA, Chien SQ. An in situ technique to retrieve an entrapped j-tip guidewire from an inferior vena cava filter. Anesth Analg 2002; 95:308-9, table of contents. [PMID: 12145040 DOI: 10.1097/00000539-200208000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPLICATIONS Entrapment of a guidewire in the vena cava filter during central venous catheter placement is a newly recognized complication. Complex techniques have been described to free the guidewire. We describe a simple in situ technique that may free the guidewire without the application of complex techniques.
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Affiliation(s)
- Muhammad A Munir
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Munir MA, Chien SQ. An In Situ Technique to Retrieve an Entrapped J-Tip Guidewire from an Inferior Vena Cava Filter. Anesth Analg 2002. [DOI: 10.1213/00000539-200208000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Loehr SP, Hamilton C, Dyer R. Retrieval of entrapped guide wire in an IVC filter facilitated with use of a myocardial biopsy forceps and snare device. J Vasc Interv Radiol 2001; 12:1116-9. [PMID: 11535778 DOI: 10.1016/s1051-0443(07)61602-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kussmaul WG, Secaira R, McCormick DJ, Cohen M. Right heart catheterization in the presence of an inferior vena cava filter. Catheter Cardiovasc Interv 2001; 52:476-8. [PMID: 11285601 DOI: 10.1002/ccd.1104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inferior vena cava filters are being inserted with increasing frequency. When such patients later require right heart catheterization, brachial or jugular vein access is usually attempted. We describe our experience in 10 consecutive patients using the standard femoral approach, first assessing filter patency and then carefully crossing the filter using a straight guidewire. The right heart chambers were successfully accessed in every case. There were no complications, and in no case did the filter migrate or become dislodged. This technique may prove useful when right heart catheterization is indicated in a patient who has a Greenfield inferior vena cava filter.
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Affiliation(s)
- W G Kussmaul
- Hahnemann University Hospital Cardiac Catheterization Laboratory, Philadelphia, Pennsylvania 19102, USA.
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Duong MH, Jensen WA, Kirsch CM, Wehner JH, Kagawa FT. An unusual complication during central venous catheter placement. J Clin Anesth 2001; 13:131-2. [PMID: 11331175 DOI: 10.1016/s0952-8180(01)00229-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 31-year-old man with disseminated Coccidioides imitis infection required central catheter placement for access. The patient had an inferior vena cava (IVC) filter placed as a result of previous deep venous thrombosis of the left lower extremity. The guidewire could not be removed following placement of the right internal jugular catheter by the Seldinger technique. Fluoroscopic examination revealed entanglement of the J-tip guidewire in the apex of the IVC filter. The catheter was successfully removed by interventional radiologists using a snare tip catheter through the left femoral vein.
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Affiliation(s)
- M H Duong
- Department of Medicine and the Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
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Liddell RP, Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD. Guidewire entrapment in a Greenfield IVC Filter:'rail and reins technique'. Clin Radiol 2000; 55:878-81. [PMID: 11069745 DOI: 10.1053/crad.2000.0520] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ascher E, Hingorani A, Tsemekhin B, Yorkovich W, Gunduz Y. Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters. J Vasc Surg 2000; 32:881-7. [PMID: 11054219 DOI: 10.1067/mva.2000.110883] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Therapy to prevent pulmonary embolism (PE) resulting from upper extremity deep venous thrombosis (UEDVT) remains controversial despite an increasing incidence of DVT of upper extremity origin. The purpose of this study was to evaluate the results of 72 superior vena cava Greenfield filters (SVC-GFs) placed in patients at risk for PE arising from UEDVT. METHODS During the past 78 months, we placed SVC-GFs in 72 patients with UEDVT in whom anticoagulation was either deemed contraindicated (n = 67) or proved ineffective in preventing recurrent PE (n = 4) or extension of the thrombus (n = 1). There were 25 male (35%) and 47 (65%) female patients whose ages ranged from 25 to 99 years (mean, 74 years). Follow-up ranged from 10 days to 78 months (mean, 7.8 months). Sequential chest radiographs revealed no filter migration or displacement in 26 patients. RESULTS Thirty-four patients died in the hospital of causes unrelated to the SVC filter or recurrent thromboembolism (mean time to death, 20 days). Follow-up of the surviving 38 patients ranged from 1 month to 78 months (mean, 22 months); none of these patients were seen with any evidence of PE. One SVC-GF was incorrectly discharged into the innominate vein and left in place. This vein remains patent 2 months after insertion without evidence of filter migration. CONCLUSIONS We think that insertion of SVC-GFs is a safe, efficacious, and feasible therapy and may prevent recurrent thromboembolism in patients with UEDVT who are resistant to anticoagulation or have contraindications to anticoagulation.
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Affiliation(s)
- E Ascher
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Streib EW, Wagner JW. Complications of vascular access procedures in patients with vena cava filters. THE JOURNAL OF TRAUMA 2000; 49:553-7; discussion 557-8. [PMID: 11003337 DOI: 10.1097/00005373-200009000-00026] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E W Streib
- Division of Trauma and Critical Care Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Andrews RT, Bova DA, Venbrux AC. How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava-atrial junction during central venous catheter placement. Crit Care Med 2000; 28:138-42. [PMID: 10667513 DOI: 10.1097/00003246-200001000-00023] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The introduction of excessive lengths of guidewire during placement of central venous catheters from the internal jugular vein (IJV) or the subclavian vein (SCV) can result in rare but significant complications. To identify a "safe" guidewire insertion length, the authors performed direct intravascular measurement of the distance from these venous access sites to the superior vena cava-atrial junction (CAJ), and evaluated these distances relative to the patients' height, weight, sex, and chest radiographs. DESIGN Prospective, nonrandomized observation. SETTING The Interventional Radiology Department of a tertiary care referral hospital. PATIENTS 100 adults (45 women, 55 men) evaluated during fluoroscopically directed central venous catheter placement. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The distance from the IJV or SCV access site was directly measured using fluoroscopy and an intravascular guidewire. 40 right IJVs, 31 right SCVs, 16 left SCVs, and 13 left IJVs were studied. Comparative measurements from the postprocedure radiograph were made in 20 of these cases. All measurements were correlated with patient sex, height, and weight. The mean distance from all access sites to the superior vena cava-atrial junction was 18.0 cm. The right IJV distance was the shortest, averaging 16 cm. The left SCV distance was the longest, averaging 21.2 cm. Right SCV and left IJV distances were 18.4 and 19.1 cm, respectively, but this difference was not statistically significant. Weight and radiographic measurements did not correlate with the measured vascular distance, although there was a trend toward longer distances in taller patients and males. CONCLUSIONS Patient height, weight, and measurements from previous chest radiographs are less reliable in predicting a safe wire length than is the access site selected. In most cases, 18 cm should be considered the upper limit of guidewire introduced during central catheter placement in adults. The guidewires supplied in catheter kits should have lengths correlated to those of the catheters, and should have distance markings printed upon them.
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Affiliation(s)
- R T Andrews
- Johns Hopkins Hospital, Baltimore, Maryland, USA
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