Guide Wire Entrapment by Inferior Vena Cava Filters: An Experimental Study

Superior vena cava filter placement over existing central venous lines: Is line removal necessary?

OBJECTIVES

To evaluate the technical feasibility and clinical safety of superior vena cava (SVC) filter placement over preexisting central venous lines (CVLs) in 23 patients who had upper extremity deep venous thrombosis with contraindications to anticoagulation.

METHODS

A retrospective review of the images and electronic medical records of 23 patients from 2008 to 2018 with SVC filters placed over an existing central venous line was performed in a single tertiary medical center. Twenty-one filters were placed over smaller lines (<8 Fr), and two were placed over hemodialysis catheters. Venograms before and after filter placement were compared to detect any evidence of line displacement or entrapment. Medical records were reviewed to determine whether there was any difficulty during line removal.

RESULTS

In two of five patients with dual lines, significant line displacement was noted in the left-sided lines, both lines were later removed without complications. In one patient with a hemodialysis catheter, the filter was deployed over the tip of the catheter resulting in the entrapment of one of the legs of the filter within a side hole of the line. Fourteen patients had their lines later removed 3 days to 3 months after filter placement without reported problems. Nine patients had their CVLs left in place until the patient's death or discharge to a long-term facility.

CONCLUSIONS

SVC filter placement over preexisting CVLs seems to be technically feasible and clinically safe in patients with <8-Fr CVLs. However, placement of the filters over hemodialysis catheters can result in leg entrapment.

Vena Cava Filters: A Synopsis of Complications and Related Topics

Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.

Guide wire entrapment in a vena cava filter: techniques for dislodgement

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of IVC filters, this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. In this article, we review the various preferred techniques reported in the literature for removal of the entrapped guide wire in particular situations, along with their indications, advantages, and disadvantages. We present simple useful recommendations to prevent this complication.

Iatrogenic Migration of VenaTech LP IVC Filter to Superior Vena Cava Secondary to Guidewire Entrapment

Modern inferior vena cava (IVC) filters are generally safe devices for preventing pulmonary embolus, with fewer complications compared to earlier techniques of caval interruption. Despite continuing improvement in filter designs and insertion methods, complications still occur. The IVC filter complications resulting from iatrogenic causes are rare and include but are not limited to misplacement, filter tilting, incomplete deployment, and filter migration. We recently experienced a problem in which the Vena Tech LP filter (B. Braun, Bethlehem, Pennsylvania) migrated to the superior vena cava (SVC) immediately after successful deployment of the filter in the infrarenal venacava. The root cause analysis of this case revealed that the complication was related to blind pullout of the J-tipped guidewire following deployment of the filter in the IVC. This report highlights the potential risks of using a wire while an IVC filter is in place.

Extended interval for retrieval of vena cava filters is safe and may maximize protection against pulmonary embolism

BACKGROUND

Retrieval of optional vena cava filters (VCF) has been demonstrated to be safe and feasible in injured patients in 4 recent studies. However, 2 pulmonary emboli PE were reported in these studies with mean implant durations less than 19 days. In light of these occurrences, we changed our practice for VCF retrieval when patients had recovered from their injuries and at least 30 days after their discharge, or had been stable on therapeutic anticoagulation for deep venous thrombosis (DVT) or PE for at least 2 weeks. The aim of the current study was to assess the safety of this approach.

METHODS

A review of prospectively collected data on optional VCF over a 16-month period. The filters were inserted prophylactically per an institutional practice guideline or for the presence of DVT or PE with a contraindication and/or complication to anticoagulation. All patients underwent duplex imaging of the lower extremities and had pre- and post- retrieval cavagrams. Demographics, duration of implantation, and complications were recorded.

RESULTS

Eighty-three patients had optional VCF inserted since the change in our clinical practice. Indications included prophylaxis for high-risk trauma patients (n = 58), DVT or PE with acute contraindication to therapeutic anticoagulation (n = 22), or complications of anticoagulation (n = 3). Two patients developed lower extremity DVT after filter insertion and 1 patient developed a vena cava thrombosis. Retrieval was successful in 47 of 54 cases (87%) attempted. Median implantation duration was 142 days (range 17-475). A filter strut fracture occurred during retrieval without further consequences. No post-insertion or post-retrieval PE occurred in this study.

CONCLUSION

Extended intervals for retrieval of VCF are safe and may maximize protection against pulmonary embolism.