Fatal migration of vena caval filters

A Novel Source of Chest Pain in the Emergency Department

This is a case report of a patient with an unusual presentation of an inferior vena cava (IVC) filter migration with a delayed presentation, and without electrical or valvular abnormalities. We discuss considerations and potential complications from IVC filter placement from the emergency physician perspective.

Efficacy and Retrievability of Aegisy Vena Cava Filter: A Single Center Experience in 213 Patients

BACKGROUND

The aim of this study was to retrospectively evaluate the safety, efficacy, and retrievability of the Aegisy vena cava filter (LifeTech Scientific Co. Ltd, Shenzhen, China).

METHODS

Data from all patients who underwent Aegisy vena cava filter placement for pulmonary embolism (PE) prophylaxis during catheter-directed thrombolysis (CDT) or aspiration thrombectomy for the proximal deep venous thrombosis (DVT) were included and analyzed.

RESULTS

From October 2006 to September 2015, a total of 213 patients were included in this study. All the filters were successfully placed without any difficulty. Filter removal was attempted in 112 (52.6%) patients after a median duration of 12 days (range 9-15) of placement, and were successful in 107 (95.5%) patients. Venography was performed pre- and post-filter removal, severe tilt was seen in 5 (4.5%, 5/112) patients, and neither filter migration nor deformity was seen in any of the patients. No procedure-related complication was observed in any of the patients. A total of 47 (22.1%) patients underwent thorax or pulmonary computed tomography for cancer or other reasons before the filters were retrieved, and no segmental PE was seen. Also, no symptomatic PE breakthrough was seen in any of the patients after the filter placement.

CONCLUSIONS

Aegisy vena cava filter is a safe and effective device for PE prophylaxis during CDT or aspiration thrombectomy for the proximal DVT. Although only half patients presented for removal, the retrievability of Aegisy vena cava filter is high.

Caval Penetration by Inferior Vena Cava Filters

Background—

Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.

Methods and Results—

The MEDLINE database was searched for all studies (1970–2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.

Conclusions—

Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.

Inferior vena cava filters: a concise review

Venous thromboembolic disease is associated with significant morbidity and mortality. Anticoagulation has been the mainstay of treatment and prevention. Unfortunately, anticoagulation frequently fails or is contraindicated. Use of inferior vena cava filters can be an effective alternative in these scenarios. Though inferior vena cava filters have been used for > 4 decades, the evidence behind their use is limited. Use of IVC filters is associated with both minor and major complications. More randomized prospective trials are needed to evaluate these devices. In this article, we review issues concerning the use of inferior vena cava filters.

[Vena cava filters in trauma patients]

BACKGROUND

The introduction of removable inferior vena cava filters (IVCF) has created new options for the prevention of pulmonary embolisms in surgical trauma patients. We have observed increasing use in trauma patients.

PATIENTS AND METHODS

A retrospective analysis was carried out of 49 trauma patients out of 85 who received IVCFs at our level 1 trauma centre in 2008.

RESULTS

The indications for IVCF placement were multiple trauma in 33 patients, severe head injury in 13 and spinal injury in 3 patients. Of the patients 34 underwent successful removal, 11 (22%) patients had had no retrieval attempt by December 2009 and attempts at removal were unsuccessful in 3 patients. The mean age of the patients was 33.3 years.

CONCLUSION

In 2008 the vast majority of IVCFs were inserted for prophylaxis in trauma patients. To increase the number of retrieved IVCFs, responsibility for the removal should be clarified in every hospital. The indications, advantages, safety and also the design of IVCFs are still under debate. A randomized controlled trial is needed to determine the appropriate use and indications for this potentially useful device in trauma patients.

Vena Cava Filter Insertion and the General Surgery Armamentarium: A 13-Year Experience

The prevention of pulmonary emboli has a long surgical history. Through the development of percutaneous technologies, vena cava filters (VCFs) are now commonly inserted by interventional radiologists. This study reviews our experience with VCFs inserted by general surgeons. We retrospectively reviewed data from our VCF performance improvement database, which is a prospective collection of the VCF experience of the Department of General Surgery from February 1996 to May 2009. Demographics, procedural information, and complications were recorded. Eight hundred fifty-five VCFs were inserted in 853 patients. The mean age was 42.0 years (range, 14 to 90 years). One hundred ninety-seven VCFs were placed in the operating room, and 658 were placed in the intensive care unit. Twelve VCFs were intentionally inserted in a suprarenal position, and four were placed in the superior vena cava. Two patients received both superior vena cava and inferior vena cava filters. Complications included deep vein thrombosis at the insertion site (n = 16), vena cava thrombosis (n = 9), post-VCF pulmonary embolism (n = 2), and a ventricle perforation requiring operative repair (n = 1). No deaths were attributed to the presence of a VCF. Overall insertion success was 99.8 per cent. In two patients, an inferior VCF could not be placed as a result of inferior vena cava occlusion with no safe “landing zone” for deployment. The placement of VCFs is a vital skill in the general surgery armamentarium. Our experience demonstrates that general surgeons can safely insert VCFs with minimal perioperative complications.