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Zhou M, Qi L, Gu Y. Successful retrieval of dislocated inferior vena cava filter using double vascular sheaths docking technology: case report. Thromb J 2021; 19:56. [PMID: 34404429 PMCID: PMC8371774 DOI: 10.1186/s12959-021-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dislocation of inferior vena cava filter (IVCF) is a rare complication with potential IVC perforation and other life-threatening risks requiring early diagnosis and in-time retrieval. Most of dislocation IVCF in the past have been shelved or removed by open surgery. It is very difficult to retrieve the filters by interventional technology. CASE PRESENTATION Here we report a 49-year-old man suffering from dislocation of IVCF implanted due to deep vein thrombosis (DVT) in the right femoral vein. Successful retrieval of the IVCF using double sheaths docking technique was done soon after confirmation of the dislocation. Importance of monitoring and early detection of dislocation of IVCF should be emphasized to avoid further complications. CONCLUSIONS The double vascular sheaths docking technique can be considered as a preferential option in difficult operative situation.
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Affiliation(s)
- Mi Zhou
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China
| | - Lixing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China.
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2
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Al Manasra ARA, Tawalbeh RA, Al-Qaoud DI, Ayesh MH, Al-Omari MH, Manasreh T, Fataftah J. Migrated Inferior Vena Cava (IVC) Filter Strut: A Rare Cause of Chronic Distal Pancreatitis with Likely Malignant Transformation. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929599. [PMID: 33707408 PMCID: PMC7957838 DOI: 10.12659/ajcr.929599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Female, 44-year-old Final Diagnosis: Pancreatic adenocarcinoma Symptoms: Abdominal pain Medication:— Clinical Procedure: Neoplasm Specialty: Surgery
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Affiliation(s)
- Abdel Rahman A Al Manasra
- Departmet of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra'fat A Tawalbeh
- Departmet of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Doaa I Al-Qaoud
- Departmet of Pediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mahmoud H Ayesh
- Departmet of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mamoon H Al-Omari
- Departmet of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarek Manasreh
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jehad Fataftah
- Department of Radiology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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3
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Hashimoto T, Koizumi J, Yamamoto K, Nishibe T, Dardik A, Shibamoto Y. Respiratory changes in the length of the vena cava: implications for optimal positioning of inferior vena cava filter. INT ANGIOL 2019; 38:90-95. [PMID: 30650948 DOI: 10.23736/s0392-9590.19.04021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A transjugular temporary inferior vena cava (IVC) filter may change position with respiration, leading to serious complications such as filter migration to the right atrium (RA) or renal veins. We therefore evaluated respiratory changes in the length and diameter of the vena cava using MRI. METHODS In 20 volunteers, the length and diameter of the vascular segments from the right brachiocephalic vein (BCV) to infrarenal IVC were measured with MRI. RESULTS The mean lengths in mm of the BCV, superior vena cava (SVC), RA, suprarenal IVC, and infrarenal IVC during expiration vs. inspiration were 32.7±7.3 vs. 43.0±8.0, 44.6±9.6 vs. 58.5±12.7, 77.8±12.4 vs. 98.9±10.0, 104.6±19.1 vs. 85.0±14.9, and 49.0±8.7 vs. 33.8±9.7, respectively (all P<0.01). The distances in mm from the BCV to RA, upper confluence of the renal vein, and lower confluence of the renal vein during expiration vs. inspiration were 155.2±18.5 vs. 200.4±20.1, 259.7±28.5 vs. 285.4±23.5, and 308.7±31.6 vs. 319.1±24.9, respectively (all P<0.01). The diameter of the SVC decreased with inspiration, while that of the infrarenal IVC increased. The diameter of the suprarenal IVC did not change significantly with respiration. CONCLUSIONS The distances from the BCV to RA, upper, and lower confluences of the renal vein were 4.5, 2.6, and 1.0 cm longer on average at inspiration than at expiration, respectively. These respiratory-associated changes of the vena cava length should be taken into account when deploying an IVC filter to prevent its migration.
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Affiliation(s)
- Takeshi Hashimoto
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Kazuyuki Yamamoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Yuta Shibamoto
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan -
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Makaryus M, Sahni S, Kumar A, Shah RD, Cohen SL, Mehrishi S, Talwar A. Right Ventricular Perforation and Subsequent Cardiac Tamponade Caused by IVC Filter Strut Fracture Migration. J Acute Med 2017; 7:87-91. [PMID: 32995178 PMCID: PMC7517970 DOI: 10.6705/j.jacme.2017.0702.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cardiac tamponade, if not recognized and treated immediately, is a life threatening condition with various etiologies. Most common causes of cardiac tamponade encountered in emergency rooms are due to trauma, post myocardial infarction wall rupture, cancer and all other causes of pericardial effusion. Iatrogenic causes of cardiac tamponade include anticoagulation and procedures related. Currently there is a general comfort level amongst physicians that inferior vena cava (IVC) filters are not associated with significant complications. However, one of the feared life-threatening immediate complications of IVC filter placement is complete migration of the filter to the heart, with possible risk for cardiac arrhythmia, cardiac tamponade, and death. IVC filter strut fracture and migration to the heart and pulmonary arteries is another possible cause of cardiac tamponade and needs to be added to the differential diagnosis in the setting of tamponade signs and symptoms in a patient with history of IVC filter placement. We present a case of IVC filter strut fracture and migration to the right ventricle with penetration of the free wall causing cardiac tamponade with subsequent successful percutaneous retrieval. We hope to raise awareness through this case of the rare but potentially fatal complications of IVC filter placement and to advise regarding the judicious use of IVC filters.
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Affiliation(s)
- Mina Makaryus
- Northwell Health Department of Pulmonary, Critical Care, & Sleep Medicine New Hyde Park, NY United States
| | - Sonu Sahni
- Northwell Health Department of Pulmonary, Critical Care, & Sleep Medicine New Hyde Park, NY United States
- Touro College of Osteopathic Medicine Department of Primary Care New York, NY United States
| | - Arjun Kumar
- New York University College of Arts and Sciences New York, NY United States
| | - Rakesh D Shah
- Northwell Health Department of Radiology Manhasset, NY United States
| | - Stuart L Cohen
- Northwell Health Department of Radiology Manhasset, NY United States
| | - Sandeep Mehrishi
- Northwell Health Department of Pulmonary, Critical Care, & Sleep Medicine New Hyde Park, NY United States
| | - Arunabh Talwar
- Northwell Health Department of Pulmonary, Critical Care, & Sleep Medicine New Hyde Park, NY United States
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5
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Hesterberg K, Babu A, Frank M, Hogan S, Krantz MJ. Severe tricuspid regurgitation due to valvular entrapment of an inferior vena cava stent. Clin Case Rep 2017; 5:130-133. [PMID: 28174637 PMCID: PMC5290522 DOI: 10.1002/ccr3.812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/18/2016] [Accepted: 12/06/2016] [Indexed: 12/03/2022] Open
Abstract
Endovascular venous stenting is increasingly performed for a variety of conditions. Inferior vena cava stent migration has been reported up to 6 months after placement; stent migration 6 months after implantation is uncommon. To our knowledge, this is only the second reported case of late stent migration with valve entrapment 1.
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Affiliation(s)
| | - Ashok Babu
- University of Colorado, Cardiothoracic Surgery Aurora, Colorado USA
| | - Maria Frank
- Denver Health Medical Center Denver Colorado USA
| | - Shea Hogan
- Denver Health Medical Center Denver Colorado USA
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6
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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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Ferraro F, Di Gennaro TL, Torino A, Petruzzi J, d’Elia A, Fusco P, Marfella R, Lettieri B. Caval filters in intensive care: a retrospective study. Drug Des Devel Ther 2014; 8:2213-9. [PMID: 25395837 PMCID: PMC4227645 DOI: 10.2147/dddt.s68026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity. BACKGROUND The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective. MATERIALS AND METHODS We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted. RESULTS In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication. CONCLUSION CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outcome in order to promote CVF implant as a safe prophylaxis option.
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Affiliation(s)
- F Ferraro
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - TL Di Gennaro
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - A Torino
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - J Petruzzi
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - A d’Elia
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - P Fusco
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - R Marfella
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy
| | - B Lettieri
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
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8
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El-Daly I, Reidy J, Culpan P, Bates P. Thromboprophylaxis in patients with pelvic and acetabular fractures: A short review and recommendations. Injury 2013; 44:1710-20. [PMID: 23816168 DOI: 10.1016/j.injury.2013.04.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/07/2013] [Accepted: 04/28/2013] [Indexed: 02/02/2023]
Abstract
The management of thromboprophylaxis in patients with pelvic and acetabular fractures remains a highly controversial topic within the trauma community. Despite anticoagulation, venous thromboembolism (VTE) remains the most common cause of surgical morbidity and mortality in this high-risk patient group. Although various thromboprophylactic regimes are employed, evidence relating to the most effective method remains unclear. Controversies surrounding screening, the use of prophylactic inferior vena cava filters (IVCF) and chemothromboprophylaxis in polytraumatised patients, particularly those with pelvic and acetabular fractures, form the basis of considerable debate. With the absence of a well-designed clinical trial and the presence of ongoing controversies within the literature, this review will explore current treatment options available to trauma surgeons and highlight differing scientific opinions, providing an update on the role of screening and current available preventative measures. We cover existing as well as recent advances in chemical thromboprophylactic agents and discuss external mechanical compression devices, the usefulness of serial duplex ultrasonography and the role of extended chemothromboprophylaxis on discharge. The evidence behind prophylactic IVCF is also considered, along with reported complication profiles. We conclude with a proposed protocol for use in major trauma centres, which can form the basis of local policy for the prevention of VTE in trauma patients with pelvic and acetabular fractures.
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Affiliation(s)
- Ibraheim El-Daly
- The Royal London Hospital, Barts Health NHS Trust, Department of Trauma and Orthopaedic Surgery, Whitechapel, London E1 1BB, UK.
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9
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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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10
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Bélénotti P, Sarlon-Bartoli G, Bartoli MA, Benyamine A, Thevenin B, Muller C, Serratrice J, Magnan PE, Weiller PJ. Vena Cava Filter Migration: An Unappreciated Complication. About Four Cases and Review of the Literature. Ann Vasc Surg 2011; 25:1141.e9-14. [DOI: 10.1016/j.avsg.2011.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 02/03/2023]
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11
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Kim HJ, Chang NK, Lim JH, Kim JK. Fracture of a Tempofilter II: an initial case report. Korean J Radiol 2011; 12:626-8. [PMID: 21927565 PMCID: PMC3168805 DOI: 10.3348/kjr.2011.12.5.626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/22/2011] [Indexed: 11/15/2022] Open
Abstract
Tempofilter II is a device that is used for pulmonary embolism prophylaxis. Since the appearance of the Tempofilter II following withdrawal of the Tempofilter I, it has been reported that the Tempofilter II is safe, effective and useful. Here we report on the first case of a fracture of one leg of the filter and this leg was embedded in the inferior vena cava wall in a 62-year-old man with deep vein thrombosis.
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Affiliation(s)
- Hyung Jun Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju 501-757, Korea
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12
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Yim NY, Chang NK, Lim JH, Kim JK. Retrograde Tempofilter II™ placement within the superior vena cava in a patient with acute upper extremity deep venous thrombosis: the filter stands on its head. Korean J Radiol 2011; 12:140-3. [PMID: 21228951 PMCID: PMC3017879 DOI: 10.3348/kjr.2011.12.1.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/24/2010] [Indexed: 11/15/2022] Open
Abstract
The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofilter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis.
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Affiliation(s)
- Nam Yeol Yim
- Department of Radiology, The Armed Forces Yangju Hospital, Gyeonggi-do 482-863, Korea.
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13
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Desjardins B, Kamath SH, Williams D. Fragmentation, Embolization, and Left Ventricular Perforation of a Recovery Filter. J Vasc Interv Radiol 2010; 21:1293-6. [DOI: 10.1016/j.jvir.2010.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/27/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022] Open
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14
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Volume associated dynamic geometry and spatial orientation of the inferior vena cava. J Vasc Surg 2009; 50:835-42; discussion 842-3. [DOI: 10.1016/j.jvs.2009.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/04/2009] [Accepted: 05/04/2009] [Indexed: 12/17/2022]
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15
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Murphy EH, Johnson ED, Kopchok GE, Fogarty TJ, Arko FR. Crux vena cava filter. Expert Rev Med Devices 2009; 6:477-85. [PMID: 19751120 DOI: 10.1586/erd.09.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inferior vena cava filters are widely accepted for pulmonary embolic prophylaxis in high-risk patients with contraindications to anticoagulation. While long-term complications have been associated with permanent filters, retrievable filters are now available and have resulted in the rapid expansion of this technology. Nonetheless, complications are still reported with optional filters. Furthermore, device tilting and thrombus load may prevent retrieval in up to 30% of patients, thereby eliminating the benefits of this technology. The Crux vena cava filter is a novel, self-centering, low-profile filter that is designed for ease of delivery, retrievability and improved efficacy while limiting fatigue-related device complications. This device has been proven safe and user-friendly in an ovine model and has recently been implanted in human subjects.
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Affiliation(s)
- Erin H Murphy
- General Surgery Resident, University of Texas Southwestern Medical Center, Dallas, TX 75903, USA
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16
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Owens CA, Bui JT, Knuttinen MG, Gaba RC, Carrillo TC, Hoefling N, Layden-Almer JE. Intracardiac Migration of Inferior Vena Cava Filters. Chest 2009; 136:877-887. [DOI: 10.1378/chest.09-0153] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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18
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Murphy EH, Johnson ED, Arko FR. Evaluation of wall motion and dynamic geometry of the inferior vena cava using intravascular ultrasound: implications for future device design. J Endovasc Ther 2008; 15:349-55. [PMID: 18540710 DOI: 10.1583/08-2424.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To use intravascular ultrasound (IVUS) to define the wall motion of the inferior vena cava (IVC) during normal respiratory cycles and evaluate its dynamic geometry during Valsalva maneuvers. METHODS Between September 2005 and October 2006, 10 patients who were having IVC filters placed underwent IVUS prior to filter implantation. With the anesthetized patient in a supine position, a 10-second IVUS recording of IVC motion below the renal veins was made during both normal respiratory cycles and Valsalva maneuvers. Diameters (n = 100 measurements) were measured from the epicenter of the lumen in both a long and short axis. Changes in diameters were evaluated using a Student t test for paired data; variations in IVC wall motion circumference of the vessel were compared using an analysis of variance for repeated measurements. Intra-/interobserver variability was analyzed with Bland-Altman plots. RESULTS The mean IVC diameter was 14.3+/-4.1 mm in the short axis and 23.2+/-3.5 mm in the long axis. There was significant variation in infrarenal IVC wall movement about the circumference, with 1.4+/-0.2 mm (range 0.6-1.8) displacement in the short axis and 1.0+/-0.2 mm (range 0.2-1.4) displacement in the long axis during the normal respiratory cycle (p = 0.04). In the short axis, the IVC diameter significantly increased with Valsalva from 14.3+/-4.1 to 19.6+/-1.2 mm (p = 0.0001); in the long axis, the diameter increased from 23.2+/-3.5 to 24+/-1.2 mm (p = 0.02). With Valsalva, there was a significantly greater change in the short axis (30.9%+/-4.8%) compared to the long axis (3.4%+/-2.2%; p = 0.0001). There were no significant differences in the interobserver and intraobserver measurements. CONCLUSION In the supine position, the IVC is elliptical and deforms anisotropically during the normal respiratory cycle. The greatest displacement (36%) is in the short axis during a Valsalva maneuver. These profound changes within the venous system will require intracaval devices to have active fixation to prevent migration. Devices should be designed to accommodate these changes to prevent fatigue failure.
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Affiliation(s)
- Erin H Murphy
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75903, USA
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19
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Girard S, Antohe J, Walsh P. Unintended consequences. Vena cava filter migration. Am J Med 2008; 121:770-1. [PMID: 18724964 DOI: 10.1016/j.amjmed.2007.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/28/2007] [Accepted: 12/03/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Scott Girard
- Internal Medicine, Geisinger Clinic, 100 North Academy Avenue, Danville, PA 17822, USA.
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20
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Thorning G. Late, Fatal Complication of an Inferior Vena Cava Filter. J Intensive Care Soc 2007. [DOI: 10.1177/175114370700800313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Geoff Thorning
- SpR Critical Care and Anaesthesia King's College Hospital London, SE5 9RS
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21
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Vergara GR, Wallace WF, Bennett KR. Spontaneous migration of an inferior vena cava filter resulting in cardiac tamponade and percutaneous filter retrieval. Catheter Cardiovasc Interv 2007; 69:300-2. [PMID: 17191236 DOI: 10.1002/ccd.21010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Thromboembolic disease accounts for thousands of hospitalizations every year in the US. Its primary management consists of anticoagulation. However, in certain instances this may be contraindicated or not sufficient. Mechanic occlusion of the inferior vena cava (IVC) becomes then a viable alternative. In this case a 35-year-old man presented with a saddle pulmonary embolus but was unable to be anticoagulated due to intestinal bleed. A removable IVC filter was then placed. The filter spontaneously migrated into the right atrium causing severe tricuspid regurgitation, perforation of the atrial wall, and cardiac tamponade. The device was successfully retrieved percutaneously and the patient discharged from the hospital in stable condition. This case illustrates the potentially lethal complications associated with the use of IVC filters, as well as the possibility to percutaneously recover them from within the right atrium.
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Affiliation(s)
- Gaston R Vergara
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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22
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Sakai Y, Masuda H, Arai G, Kobayashi T, Kageyama Y, Kihara K. Accidental dislocation of an intracaval temporary filter into the heart in a case of renal cell carcinoma extending into the vena cava. Int J Urol 2006; 13:1118-20. [PMID: 16903941 DOI: 10.1111/j.1442-2042.2006.01510.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In a case of renal cell carcinoma extending into the vena cava, a temporary intracaval filter was applied before surgery to prevent pulmonary artery thrombosis. Two days later, the filter accidentally migrated into the right ventricle during defecation. Fortunately, it was successfully removed without damaging cardiac musculature under fluoroscopy.
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Affiliation(s)
- Yasuyuki Sakai
- Department of Urology and Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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23
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Bovyn G, Ricco JB, Reynaud P, Le Blanche AF. Long-duration temporary vena cava filter: A prospective 104-case multicenter study. J Vasc Surg 2006; 43:1222-9. [PMID: 16765244 DOI: 10.1016/j.jvs.2006.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 02/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nonpermanent caval filters are placed in critical thromboembolic situations in which anticoagulation therapy is transiently contraindicated, ineffective, or the source of complications. The purpose of this study was to assess the safety and effectiveness of a second-generation long-duration temporary caval filter in these situations and compare its utility with that of other temporary filters. METHODS This prospective study, including patients who underwent temporary caval filtration with the Tempofilter II, was conducted in nine European centers. All filters were successfully implanted. The filter was removed when the indication for caval filtration ceased. RESULTS A total of 104 filters were inserted in 103 patients with an average age of 60 +/- 15.5 years (range, 22-92 years). Most patients (85%) had pulmonary embolism, deep venous thrombosis, or both. The main indications for caval filter placement were complications of or contraindications to anticoagulation therapy (n = 85; 82.5%) or for ineffectiveness of anticoagulation therapy (n = 12; 11.7%). The average duration of implantation was 29.5 +/- 14.0 days (range, 2-86 days). One filter migrated in the right atrium, followed by pulmonary embolism. No other case of pulmonary embolism or of infectious or mechanical complications related to the filter was observed. Thrombus was trapped within the filter in 24 cases (23.3%). All filters but one were removed, regardless of whether thrombus had been trapped. Retrieval was always successful after implantation periods up to 12 weeks. In 16 cases (15.5%), the filter was replaced by a permanent filter. CONCLUSIONS The Tempofilter II is safe, effective, and useful in critical thromboembolic situations. It offers a valuable alternative to retrievable optional filters.
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Affiliation(s)
- Gilles Bovyn
- Vascular Surgery Department, Hospital Y. Le Foll, Saint Brieuc, France
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24
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Saeed I, Garcia M, McNicholas K. Right Ventricular Migration of a Recovery IVC Filter’s Fractured Wire with Subsequent Pericardial Tamponade. Cardiovasc Intervent Radiol 2006; 29:685-6. [PMID: 16604409 DOI: 10.1007/s00270-005-0136-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A Recovery filter (C.R. Bard, Tempe, AZ, USA) is a device for pulmonary embolism prophylaxis. There have been few case reports involving the migration of this particular filter or of a broken wire migrating to the heart. We report a case of right ventricular migration of a fractured wire from this filter in a patient who subsequently developed pericardial tamponade and required open heart surgery to extract the fractured wire. We discuss the current US Food and Drug Administration (FDA)-approved nonpermanent inferior vena cava filters and their reported complications. These complications can be life-threatening and may require immediate surgical intervention.
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Affiliation(s)
- Imran Saeed
- MAP 2, Suite 2121, Christiana Hospital, 4745 Ogletown-Stanton Road, Newark, DE 19713, USA.
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25
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Terhaar OA, Lyon SM, Given MF, Foster AE, Mc Grath F, Lee MJ. Extended Interval for Retrieval of Günther Tulip Filters. J Vasc Interv Radiol 2004; 15:1257-62. [PMID: 15525745 DOI: 10.1097/01.rvi.0000134497.50590.e2] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the Gunther Tulip vena cava filter with regard to ease of placement, complications, and retrieval over long time periods. MATERIALS AND METHODS In 53 patients (ratio of men to women, 24:29; mean age, 52.8 years) retrievable Gunther Tulip filters (Vena Cava M Reye Filter Set; William Cook Europe, Denmark) were inserted. Indications included planned major surgery with recent pulmonary embolus or high pulmonary embolus risk (n = 16), extensive ilio-femoral thrombus (n = 11), deep vein thrombosis with anticoagulant complications (n = 9), breakthrough pulmonary embolus despite anticoagulant therapy (n = 4), and contraindication to anticoagulant therapy (n = 13). All patients were followed-up for immediate and long-term complications. RESULTS Fifty-three filters were successfully placed in 52 of 53 patients, yielding a success rate of 98.1%. Nineteen patients underwent attempted retrieval of their filter. Sixteen of 19 retrieval procedures were successful (84%). In three patients, the filter could not be removed on attempted retrieval (extensive filter thrombus in two patients and attachment to the wall in one patient). One patient received two filters, which were both successfully retrieved at a later date. Median implantation time for retrievable filters was 34 days (range, 7-126 days). Mean follow-up for patients with permanent filters was 13 months. Two major complications (pneumothorax and break through pulmonary embolus) and three minor complications (right internal jugular vein thrombosis in two patients and transient Horner's Syndrome in one patient) were recorded. CONCLUSION Insertion and retrieval of filters is safe and feasible. Preliminary data suggest that Gunther Tulip filter retrieval is feasible over and above the manufacturer's recommended retrieval interval of 14 days.
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Affiliation(s)
- Olaf Alfons Terhaar
- Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin 9, Ireland
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26
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Actis Dato GM, Arslanian A, Di Marzio P, Filosso PL, Ruffini E. Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature. J Thorac Cardiovasc Surg 2003; 126:408-14. [PMID: 12928637 DOI: 10.1016/s0022-5223(03)00399-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our experience with posttraumatic and iatrogenic foreign bodies in the heart is presented and discussed along with a review of the literature on this subject. SUMMARY BACKGROUND DATA Posttraumatic or iatrogenic foreign bodies in the heart can be treated either conservatively or surgically. Controversy exists about optimal management. METHODS Fourteen cases of posttraumatic or iatrogenic foreign bodies in the heart observed between 1955 and 2000 were studied. Our series includes the following: bullets into the right or left ventricle (4 cases); needles in the left ventricle, atrium, and pulmonary artery (3 cases); retained catheter fragments in the right ventricle, right atrium, or in the pulmonary artery (4 cases); a grenade fragment into the right atrium (1 case); a circular saw fragment into the right ventricle (1 case); and a commissurotomy ring into the left atrium (1 case). RESULTS Foreign bodies were removed when in the cardiac cavities (1 case); when in the presence of associated risk factors like embolism, arrhythmia, or infection (3 cases); and when in the presence of associated signs or symptoms including cardiac tamponade (2 cases), arrhythmia (1 case), fever (2 cases), or anxiety (1 case). Removal was accomplished by a thoracotomy (7 cases) or sternotomy (2 cases), with (3 cases) or without cardiopulmonary bypass, or percutaneously (1 case). Four asymptomatic patients were conservatively treated and have no evidence of complications at a median follow-up of 20 years. CONCLUSIONS The management of foreign bodies in the heart should be individualized: (1) symptomatic foreign bodies should be removed irrespective of their location; (2) asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; (3) asymptomatic foreign bodies without associated risks factors or diagnosed late after the injury may be treated conservatively, particularly if they are completely embedded in the myocardium or in the pericardium.
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Millward SF, Oliva VL, Bell SD, Valenti DA, Rasuli P, Asch M, Hadziomerovic A, Kachura JR. Günther Tulip Retrievable Vena Cava Filter: results from the Registry of the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2001; 12:1053-8. [PMID: 11535767 DOI: 10.1016/s1051-0443(07)61590-5] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To report data collected by the Canadian Registry of the Günther Tulip Retrievable Filter (GTF). MATERIALS AND METHODS Between February 1998 and December 2000, 90 patients at eight hospitals underwent implantation of 91 GTFs. There were 45 male patients and 45 female patients, age 17-88 years, with a mean age of 49 years. Indications for filter placement were pulmonary embolism (PE) or deep vein thrombosis (DVT) with a contraindication to anticoagulation in 83 patients, prophylaxis after massive PE in one, prophylaxis for proximal free-floating thrombus in one, and prophylaxis with no DVT or PE in six patients (major trauma, n = 4; high preoperative risk, n = 2). GTF retrieval was attempted in selected patients from a right internal jugular vein approach. RESULTS One GTF was inadvertently placed in the right iliac vein and could not be retrieved. There were no other major placement complications. GTF retrieval was attempted in 52 patients (53 GTFs); 52 GTFs were successfully retrieved from 51 patients. Implantation times were 2-25 days (mean, 9 d). Of these 51 patients, 37 underwent follow-up for 5-420 days (mean, 103 d) after filter retrieval. Four patients (8% of retrieved GTFs) required reinsertion of a permanent filter 17-167 days (mean, 78 d) after GTF retrieval as a result of bleeding from anticoagulation (n = 2) or because the patient required further surgery (n = 2). One other patient had recurrent DVT 230 days after retrieval; no PE or other complication was documented in the retrieval group. GTFs were not retrieved from 39 patients for various reasons. Of these 39 patients, 25 underwent follow-up 7-420 days (mean, 85 d) after filter placement. Two patients developed filter occlusion (5%); no other complications were documented. CONCLUSION The GTF has a broad range of utility: it can be used as a permanent filter or retrieved after implantation periods of 15 days and possibly longer. However, indications for retrieval require further study, as does the maximum implantation time.
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Affiliation(s)
- S F Millward
- Department of Radiology, London Health Sciences Centre, University of Western Ontario, London, Canada.
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28
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Abstract
RATIONALE AND OBJECTIVES The authors performed this study to evaluate the (a) ability of a prototype temporary inferior vena caval (IVC) filter to trap and retain emboli in an ex vivo flow circuit, (b) feasibility of filter placement and removal via a superficial vein in sheep, and (c) intermediate-term effects of the filter on the insertion vein and at the filter site. MATERIALS AND METHODS In an iliocaval circuit, embolus capture with the prototype filter was compared to that with a Greenfield filter. In addition, prototype filters were placed into the infrarenal IVC in six sheep. Placement via a superficial venous route was initially attempted. Inferior vena cavography was performed weekly, and filters were removed after 2, 3, or 4 weeks (n = 2 each). Two weeks after the filters were removed, vena cavograms were obtained, the animals were sacrificed, and the IVC was evaluated at pathologic examination. RESULTS The prototype filter captured all emboli, and the Greenfield filter captured 70%-100% of emboli. Successful placement via a superficial venous route was accomplished in only two sheep owing to small vein caliber; four filters were placed via a deep vein. Adverse events included perifilter thrombus, insertion site infection, and caudal migration. Two sheep died before filter removal owing to sepsis and anesthetic complications. The filters in the remaining four sheep were easily and successfully removed. Five sheep had stenosis at the filter site, and fibrosis with acute and chronic inflammation was seen at microscopic examination. CONCLUSION The prototype filter trapped emboli as well as the Greenfield filter. Insertion via a superficial route, however, is possible only if the access vein is of an adequate size.
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Affiliation(s)
- M S Stecker
- Department of Radiology, Indiana University School of Medicine, University Hospital, Indianapolis 46202-5253, USA
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