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Annweiler T, Bertoletti L, Grange S, Peoc’h M, Mismetti P, Barral FG. Pathological Analysis and Clinical Evolution After Radiological Removal of Retrievable Vena Cava Filters. Vasc Endovascular Surg 2022; 56:754-761. [DOI: 10.1177/15385744221120764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Retrievable inferior vena cava filters (IVCF) have been developed because permanent filters have been associated with an increased risk of recurrent deep venous thrombosis. There is no data on the interactions of IVCF with the inferior vena cava (intrafilter thrombi, insertion through the venous wall) even though this may alter the course after retrieval of the IVCF. Methods A review of 85 consecutive patients undergoing retrieval of IVCF placed at a single center was performed from January 1, 2010 and December 31, 2014. Inferior vena cava filter were examined for presence of intrafilter thrombus at time of retrieval. Filter position and presence of intraluminal thrombus were examined. Patient outcomes, including recurrence of deep vein thrombosis (DVT) and death, were captured at 3 month followup. Results Eighty five patients were identified, with intrafilter thrombi found in 69 (81%) patients and venous wall fragments found in 75 (88%) patients. However, their presence was not associated with an increased risk of recurrent venous thromboembolism (VTE) or death during follow up. Conclusions Intrafilter thrombi and venous wall fragments are frequently found in removed IVCF but are not associated with a worse prognosis. They may not modify the therapeutic management of patients.
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Affiliation(s)
- Thierry Annweiler
- Service de Radiologie, Centre Hospitalier Universitaire de St-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Sylvain Grange
- Service de Radiologie, Centre Hospitalier Universitaire de St-Etienne, Saint-Etienne, France
| | - Michel Peoc’h
- Department of Pathology, CHU de St-Etienne, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Fabrice-Guy Barral
- Service de Radiologie, Centre Hospitalier Universitaire de St-Etienne, Saint-Etienne, France
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Weinberg I, Bjarnason H. Great Debates in Vascular Medicine: Should all inferior vena cava (IVC) filters be removed? Vasc Med 2018; 23:75-77. [PMID: 29320958 DOI: 10.1177/1358863x17746247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ido Weinberg
- 1 Vascular Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Haraldur Bjarnason
- 2 Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
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Hohenwalter EJ, Stone JR, O’Moore PV, Smith SJ, Selby JB, Lewandowski RJ, Samuels S, Kiproff PM, Trost DW, Madoff DC, Handel J, Gandras EJ, Vlahos A, Rilling WS. Multicenter Trial of the VenaTech Convertible Vena Cava Filter. J Vasc Interv Radiol 2017; 28:1353-1362. [DOI: 10.1016/j.jvir.2017.06.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023] Open
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Consequences of Venous Thromboembolism, Including Chronic Thromboembolic Pulmonary Hypertension. Crit Care Nurs Q 2017; 40:260-275. [PMID: 28557897 DOI: 10.1097/cnq.0000000000000164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. They pose a significant risk for morbidity and mortality. In an appropriate clinical setting, invasive interventions, including administration of thrombolytics, anticoagulation, and placement of vena cava filter, are warranted. Bleeding, postthrombotic syndrome, recurrence, and filter-associated complications are few of the complications of this disease. More recently, chronic thromboembolic pulmonary hypertension has gained clinical interest in patients with pulmonary embolism and has warranted close follow-up.
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Hemopericardium from inferior cava filter strut fracture and embolization. J Cardiovasc Comput Tomogr 2015; 10:91-2. [PMID: 26189579 DOI: 10.1016/j.jcct.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
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Abtahian F, Hawkins BM, Ryan DP, Cefalo P, Nasser NJ, MacKay C, Jaff MR, Weinberg I. Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med 2014; 127:1111-1117. [PMID: 24997415 DOI: 10.1016/j.amjmed.2014.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/01/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Venous thromboembolism contributes significantly to morbidity and mortality in cancer patients. Because cancer patients frequently have contraindications to anticoagulation, inferior vena cava filters are commonly placed. The use, safety, and retrieval of retrievable inferior vena cava filters in cancer patients have not been well studied. METHODS A retrospective review of retrievable inferior vena cava filter use at a tertiary referral hospital was conducted between January 1, 2009 and December 31, 2011. Indications for inferior vena cava filter placement, anticoagulation practices, complications, filter retrieval, and patient outcomes were analyzed for patients with and without active cancer and for cancer subtypes, including localized and metastatic cases. RESULTS Of 666 patients receiving retrievable inferior vena cava filters during this time period, 247 (37.1%) had active cancer. Of these, 151 (22.7%) had carcinoma, 92 (13.8%) had sarcoma, and 115 (17.3%) had metastatic disease. Overall, follow-up was available for a median of 401.0 (interquartile range: 107.5-786.5) days. Indwelling filter-related complications occurred in 19.8% of patients without cancer and 17.7% with an active cancer (P = .50). Patients with cancer were less likely to have the filter retrieved (28.0% vs 42.0%, P < .001). In multivariable analysis, cancer was not associated with filter-related complications but was associated with a lower rate of filter retrieval. CONCLUSIONS In a modern cohort of patients undergoing retrievable inferior vena cava filter placement, active diagnosis of cancer is not associated with a significant increase in filter-related complications, but is associated with a reduced rate of filter retrieval.
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Affiliation(s)
- Farhad Abtahian
- Cardiology Division, Massachusetts General Hospital, Boston, Mass
| | - Beau M Hawkins
- Department of Medicine, University of Oklahoma College of Medicine, Oklahoma City
| | - David P Ryan
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, Mass
| | - Philip Cefalo
- Medicine Department, Spaulding Rehabilitation Hospital, Boston, Mass
| | - Nicola J Nasser
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ont., Canada
| | - Cheryl MacKay
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Mass
| | - Michael R Jaff
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Mass
| | - Ido Weinberg
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Mass.
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Effect of delayed inferior vena cava filter retrieval after early initiation of anticoagulation. Am J Cardiol 2014; 113:389-94. [PMID: 24176068 DOI: 10.1016/j.amjcard.2013.08.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022]
Abstract
Retrievable inferior vena cava filters (IVCFs) were designed to provide temporary protection from pulmonary embolism in high-risk situations. However, little is known about their effectiveness, and many remain permanently implanted, leading to potential complications. The aim of this study was to determine patient characteristics, indications for IVCF placement, retrieval rates, complications, and post-IVCF anticoagulation (AC) practices in patients who have received IVCFs. A retrospective review of IVCF use by 3 specialty groups from January 1, 2009, to December 31, 2011, was conducted at a tertiary referral center. Indications for IVCF, procedural success and complications, post-IVCF AC practices, and patient outcomes were assessed. Seven hundred fifty-eight IVCFs were placed. Follow-up was available for 688 patients (90.7%) at a median of 342.0 days (interquartile range 81.5 to 758.0). Indications for IVCF placement included contraindication to AC in the presence of acute venous thromboembolism (n = 287 [41.7%]) and prophylaxis (n = 235 [34.2%]). Insertion-related complications occurred in 28 patients (4.1%). After IVCF placement, adequate AC was initiated in 454 patients (66.0%) <3.0 days (interquartile range 0 to 13.0) after insertion, but the overall retrieval rate was only 252 of 688 (36.6%) within a median of 134.0 days (interquartile range 72.50 to 205.8). Significant IVCF-related complications occurred in 122 patients (17.7%) within 32 days (interquartile range 13.0 to 116.8). The most common complication (72 of 131 [55.0%]) was deep vein thrombosis. In conclusion, in a large, modern cohort of patients receiving retrievable IVCFs for a variety of indications by various specialties, IVCF insertion remains safe. However, many patients have IVCF-related complications, and often, even when IVCFs are retrieved, there is a delay between AC and retrieval. Quality improvement initiatives that facilitate the expeditious retrieval of IVCF are needed.
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Nakashima M, Kobayashi H, Takenouchi Y, Nakayama T, Kobayashi M. Successful cases of difficult inferior vena cava filter retrieval with the use of biopsy forceps: Biopsy forceps technique. SAGE Open Med Case Rep 2014; 2:2050313X14547610. [PMID: 27489651 PMCID: PMC4857341 DOI: 10.1177/2050313x14547610] [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: 11/22/2013] [Accepted: 04/17/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives: For treatment and prevention of deep vein thrombosis(DVT) and pulmonary embolism(PE), retrievable inferior vena cava(IVC) filters have commonly been used as an effective bridge to anticoagulation. However, we experienced unexpected difficulty in endovascular retrieval of some IVC filters. Most problems were due to endovascular treatment devices issues, filter intimal migration, filter disintegration, filter-associated thrombosis, and right atrium/ventricle migration. Methods: Disposable biopsy forceps was used to engage the filter hook and reform the shape of the filter struts. Endovascular retrieval assisted by use of the biopsy forceps via a similar vein was effective and provided a less-invasive, low cost method for removal of problematic IVC filters. Results: We described easily performed methods that uses disposable biopsy forceps for the retrieval of IVC filters that are difficult to remove because of filter hook migration into the caval wall. Conclusion: We developed an easily performed method that uses intestine biopsy forceps for the retrieval of IVC filter that are difficult to remove.
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Affiliation(s)
- Masaya Nakashima
- Department of Vascular Surgery, Tokoname Municipal Hospital, Aichi, Japan
| | - Hideaki Kobayashi
- Department of Vascular Surgery, Tokoname Municipal Hospital, Aichi, Japan
| | - Yasushi Takenouchi
- Department of Vascular Surgery, Tokoname Municipal Hospital, Aichi, Japan
| | - Takashi Nakayama
- Department of Vascular Surgery, Tokoname Municipal Hospital, Aichi, Japan
| | - Masayoshi Kobayashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Fujita Health University, Aichi, Japan
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Uterine trauma with fetal loss associated with chronic perforation of the inferior vena cava by an infrarenal vena cava filter. J Vasc Surg Venous Lymphat Disord 2013; 1:412-4. [PMID: 26992765 DOI: 10.1016/j.jvsv.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/15/2013] [Accepted: 04/20/2013] [Indexed: 11/21/2022]
Abstract
Gestational complications in pregnant women have been considered a theoretical sequelae of vena cava filters (VCFs) positioned in the infrarenal segment of the inferior vena cava. We describe a 32-year-old woman who became pregnant with the known existence of an asymptomatic but chronically perforated, permanent infrarenal VCF. At 24 weeks gestation, uterine trauma leading to massive intraperitoneal hemorrhage and fetal loss occurred. Our case documents that gestational risk, heretofore theoretical, is real and calls for heightened awareness of the need for appropriate VCF management in women of childbearing age and consideration for preconception evaluation of the filter-bearing inferior vena cava in women considering pregnancy in whom VCFs have been previously implanted.
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Affiliation(s)
- Ido Weinberg
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, MA
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Weinberg I, Kaufman J, Jaff MR. Inferior Vena Cava Filters. JACC Cardiovasc Interv 2013; 6:539-47. [DOI: 10.1016/j.jcin.2013.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 03/01/2013] [Indexed: 01/29/2023]
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