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Desai SP, Yu CZ, Evangelista F, Gill JR. Perforation of the Heart During Elective Removal of an Inferior Vena Cava Filter. Am J Forensic Med Pathol 2024:00000433-990000000-00183. [PMID: 38833346 DOI: 10.1097/paf.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT A common treatment for venous thromboembolic disease in patients with contraindications to anticoagulation includes placement of an inferior vena cava (IVC) filter. Temporary filters are available to avoid the risk of long-term permanent placement. A woman in her 60s with a history of uterine serous carcinoma presented to the emergency department with cardiac arrest following elective attempted IVC filter removal. Three months prior, a temporary filter was placed because anticoagulation medication was stopped in preparation for a hysterectomy. During the IVC retrieval procedure, which was performed using an intravascular approach from the right jugular vein, the filter was tilted, requiring the use of a different retrieval sheath. During catheter reentry, the patient complained of discomfort in the chest and neck, after which she became hypotensive, lost consciousness, and died. Autopsy revealed 2 cardiac perforations, one in each ventricle. Approximately 600 mL of liquid and clotted blood was within the tense pericardial sac. An IVC filter was found in place, with no adjacent hemorrhage.To our knowledge, this is the first reported fatality due to cardiac perforation by an access sheath during intravascular removal of an IVC filter. This instance also documents the time course of the cardiac perforations to the resultant loss of consciousness.
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Affiliation(s)
- Sapna P Desai
- From the Office of the Chief Medical Examiner, Farmington, CT
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Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism. J Clin Med 2021; 11:jcm11010077. [PMID: 35011826 PMCID: PMC8745208 DOI: 10.3390/jcm11010077] [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] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). Methods: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. Results: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. Conclusion: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines.
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Stevens SM, Woller SC, Baumann Kreuziger L, Bounameaux H, Doerschug K, Geersing GJ, Huisman MV, Kearon C, King CS, Knighton AJ, Lake E, Murin S, Vintch JRE, Wells PS, Moores LK. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160:e545-e608. [PMID: 34352278 DOI: 10.1016/j.chest.2021.07.055] [Citation(s) in RCA: 351] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023] Open
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Hng JZK, Su S, Atkinson N. May-Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature. J Med Case Rep 2021; 15:141. [PMID: 33736685 PMCID: PMC7977182 DOI: 10.1186/s13256-021-02730-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required. Case presentation A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis. Conclusions Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.
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Affiliation(s)
- Joel Zhen Khang Hng
- Department of Vascular Surgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
| | - Shu Su
- Department of Radiology, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Noel Atkinson
- Department of Vascular Surgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
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Petrov DA, Chauhan A, Fitzpatrick S, Altman DT, Casagranda B. Inferior Vena Cava Filter Strut Penetration into the Vertebral Column: A Case of 10-Year Clinical Follow Up. Curr Probl Diagn Radiol 2020; 49:215-217. [DOI: 10.1067/j.cpradiol.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 11/22/2022]
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Morrow KL, Bena J, Lyden SP, Parodi E, Smolock CJ. Factors predicting failure of retrieval of inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2020; 8:44-52. [DOI: 10.1016/j.jvsv.2019.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022]
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The Clinical Rationale for the Sentry Bioconvertible Inferior Vena Cava Filter for the Prevention of Pulmonary Embolism. Int J Vasc Med 2019; 2019:5795148. [PMID: 31263598 PMCID: PMC6556320 DOI: 10.1155/2019/5795148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022] Open
Abstract
The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection against pulmonary embolism (PE) during transient high-risk periods and then to bioconvert after 60 days after implantation. At the time of bioconversion, the device's nitinol arms retract from the filtering position into the caval wall. Subsequently, the stable stent-like nitinol frame is endothelialized. The Sentry bioconvertible IVC filter has been evaluated in a multicenter investigational-device-exemption pivotal trial (NCT01975090) of 129 patients with documented deep vein thrombosis (DVT) or PE, or at temporary risk of developing DVT or PE, and with contraindications to anticoagulation. Successful filter conversion was observed in 95.7% of patients at 6 months (110/115) and 96.4% at 12 months (106/110). Through 12 months, there were no cases of symptomatic PE. The rationale for development of the Sentry bioconvertible device includes the following considerations: (1) the period of highest risk of PE for the vast majority of patients occurs within the first 60 days after an index event, with most of the PEs occurring in the first 30 days; (2) the design of retrievable IVC filters to support their removal after a transitory high-PE-risk period has, in practice, been associated with insecure filter dynamics and time-dependent complications including tilting, fracture, embolization, migration, and IVC perforation; (3) most retrievable IVC filters are placed for temporary protection, but for a variety of reasons they are not removed in any more than half of implanted patients, and when removal is attempted, the procedure is not always successful even with advanced techniques; and (4) analysis of Medicare hospital data suggests that payment for the retrieval procedure does not routinely compensate for expense. The Sentry device is not intended for removal after bioconversion. In initial clinical use, complications have been limited. Long-term results for the Sentry bioconvertible IVC filter are anticipated soon.
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Holleck JL, Chen EY, Bonomo J. Caval Perforation from a Malpositioned Inferior Vena Cava Filter. J Gen Intern Med 2019; 34:1358-1359. [PMID: 30972553 PMCID: PMC6614244 DOI: 10.1007/s11606-019-04933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/20/2018] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jürgen L Holleck
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Medicine,, Veterans Affairs Connecticut Healthcare System West Haven Campus, West Haven, CT, USA.
| | - Eric Y Chen
- Yale University School of Medicine, New Haven, CT, USA
| | - Jason Bonomo
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Rising Retrieval Rates of Inferior Vena Cava Filters in the United States: Insights From the 2012 to 2016 Summary Medicare Claims Data. J Am Coll Radiol 2018; 15:1553-1557. [DOI: 10.1016/j.jacr.2018.01.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/08/2018] [Accepted: 01/30/2018] [Indexed: 01/26/2023]
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Dake MD, Murphy TP, Krämer AH, Darcy MD, Sewall LE, Curi MA, Johnson MS, Arena F, Swischuk JL, Ansel GM, Silver MJ, Saddekni S, Brower JS, Mendes R, Dake MD, Feezor R, Kalva S, Kies D, Bosiers M, Ziegler W, Farber M, Paolini D, Spillane R, Jones S, Peeters P. One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter. J Vasc Interv Radiol 2018; 29:1350-1361.e4. [DOI: 10.1016/j.jvir.2018.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/25/2022] Open
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Baig S, Bert J, Gertner E. Safety of retrievable inferior vena cava filters in patients with the antiphospholipid syndrome. Eur J Rheumatol 2018; 5:100-103. [PMID: 30185357 DOI: 10.5152/eurjrheum.2018.17091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Consideration for placement of an inferior cava filter arises in patients with APS where cessation of anticoagulation is necessary or thrombotic complications continue despite maximal anticoagulation. Permanent IVC filters are recommended to be avoided. We evaluated the safety of placement and removal of retrievable inferior vena cava filters in patients with APS. METHODS Case series of 5 patients with APS and aPL antibodies who had placement and removal of retrievable IVC filter (because of contraindication to anticoagulation or ongoing thrombosis despite full anticoagulation) to assess for safety, presence of clots in the vena cava or on the filter while in the body, evidence of PE, or clot on the explanted filter. RESULTS Insertion and removal, even while on anticoagulation, was safe. There was no evidence of clot in the vena cava, on the filter or pulmonary embolism in all cases. CONCLUSION Where necessary, retrievable IVC filters may be safer in APS patients but should not be left in for long periods of time.
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Affiliation(s)
- Sara Baig
- Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Joseph Bert
- Department of Rheumatology, Regions Hospital, St. Paul, Minnesota, USA.,Department of Rheumatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Elie Gertner
- Department of Rheumatology, Regions Hospital, St. Paul, Minnesota, USA.,Department of Rheumatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Sentry Bioconvertible Inferior Vena Cava Filter: Study of Stages of Incorporation in an Experimental Ovine Model. Int J Vasc Med 2018; 2018:6981505. [PMID: 30112213 PMCID: PMC6077616 DOI: 10.1155/2018/6981505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022] Open
Abstract
The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection from pulmonary embolism (PE) and then bioconvert to become incorporated in the vessel wall, leaving a patent IVC lumen. Objective. To evaluate the performance and stages of incorporation of the Sentry IVC filter in an ovine model. Methods. Twenty-four bioconvertible devices and 1 control retrievable filter were implanted in the infrarenal IVC of 25 sheep, with extensive daily monitoring and intensive imaging. Vessels and devices were analyzed at early (≤98 days, n = 10) and late (180 ± 30 days, n = 14 study devices, 1 control) termination and necropsy time-points. Results. Deployment success was 100% with all devices confirmed in filtering configuration, there were no filter-related complications, and bioconversion was 100% at termination with vessels widely patent. By 98 days for all early-incorporation analysis animals, the stabilizing cylindrical part of the Sentry frame was incorporated in the vessel wall, and the filter arms were retracted. By 180 days for all late-incorporation analysis animals, the filter arms as well as frames were stably incorporated. Conclusions. Through 180 days, there were no filter-related complications, and the study devices were all bioconverted and stably incorporated, leaving all IVCs patent.
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Giorgi M, Ryder BA, Chong T, Malek J, Sangisetty S, Roye GD, Stafford T, Vithiananthan S. Safety of Retrievable Inferior Vena Cava Filter Placements in High-Risk Bariatric Surgery Patients. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcoandrea Giorgi
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Beth A. Ryder
- Department of Surgery, Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Tec Chong
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Junaid Malek
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Suma Sangisetty
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Gary Dean Roye
- Department of Surgery, Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Todd Stafford
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
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De Gregorio MA, Guirola JA, Lahuerta C, Serrano C, Figueredo AL, Kuo WT. Interventional radiology treatment for pulmonary embolism. World J Radiol 2017; 9:295-303. [PMID: 28794825 PMCID: PMC5529318 DOI: 10.4329/wjr.v9.i7.295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.
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Jerjes-Sanchez C, Rodriguez D, Navarrete A, Parra-Cantu C, Joya-Harrison J, Vazquez E, Ramirez-Rivera A. Inferior vena cava filters in pulmonary embolism: A historic controversy. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:155-166. [DOI: 10.1016/j.acmx.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022] Open
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COUNTERPOINT: Do the Benefits Outweigh the Risks for Most Patients Under Consideration for Inferior Vena Cava Filters? No. Chest 2016; 150:1182-1184. [DOI: 10.1016/j.chest.2016.08.1477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022] Open
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Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecol Oncol 2016; 144:420-427. [PMID: 27890280 DOI: 10.1016/j.ygyno.2016.11.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/13/2016] [Accepted: 11/21/2016] [Indexed: 01/30/2023]
Abstract
Gynecologic oncology patients are at a high-risk of postoperative venous thromboembolism and these events are a source of major morbidity and mortality. Given the availability of prophylaxis regimens, a structured comprehensive plan for prophylaxis is necessary to care for this population. There are many prophylaxis strategies and pharmacologic agents available to the practicing gynecologic oncologist. Current venous thromboembolism prophylaxis strategies include mechanical prophylaxis, preoperative pharmacologic prophylaxis, postoperative pharmacologic prophylaxis and extended duration pharmacologic prophylaxis that the patient continues at home after hospital discharge. In this review, we will summarize the available pharmacologic prophylaxis agents and discuss currently used prophylaxis strategies. When available, evidence from the gynecologic oncology patient population will be highlighted.
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Arous EJ, Messina LM. Response. Chest 2016; 150:980-981. [PMID: 27719815 DOI: 10.1016/j.chest.2016.08.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Edward J Arous
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Louis M Messina
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA; Diabetes Center of Excellence, University of Massachusetts Medical School, Worcester, MA.
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Hoffer EK. Management of Retrievable Inferior Vena Cava Filters. Chest 2016; 150:979-980. [PMID: 27719814 DOI: 10.1016/j.chest.2016.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eric K Hoffer
- Section of Interventional Radiology, Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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