Balloon Dilation of an Inferior Vena Cava Filter to Implant a Leadless Pacemaker

Navigating inferior vena cava filters in invasive cardiology procedures: A systematic review

BACKGROUND

Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCFs) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in-situ.

METHODS

Two independent reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time, and procedural specifics.

RESULTS

Out of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval = 89.54-98.1) with no heterogeneity (I²  = 0%, p = 1) and there were no reported filter-related complications.

CONCLUSION

This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.

Successful implantation of leadless pacemaker in patient with the Günther Tulip inferior vena cava filter

Leadless pacemakers have many advantages for some patients in preventing lead- and pocket-related complications. The traveling of the femoral vein is important in the context of normal approach site choice for leadless pacemakers. In this case, the leadless pacemaker could be successfully implanted without disrupting the inferior vena cava filter by using intravascular ultrasound in a hemodialysis patient with complete atrioventricular block and atrial fibrillation who had obstruction of the bilateral subclavian and right femoral veins, and travel abnormality of the left common iliac vein. <Learning objective: The leadless pacemaker is a useful option in patients with complex vascular complications and hemodialysis. However, there are several listed contraindications such as the presence of inferior vena cava (IVC) filter that was excluded in the large-scale trials to leadless pacemakers. Intravascular ultrasound is a useful tool to place the leadless pacemaker without disrupting IVC filter to maintain its filtering capability.>.