1
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Feng H, Li C, Feng H. Numerical simulation and in vitro experimental study of thrombus capture efficiency of a new retrievable vena cava filter. Comput Methods Biomech Biomed Engin 2023; 26:2034-2046. [PMID: 36625716 DOI: 10.1080/10255842.2022.2163849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023]
Abstract
The vena cava filter is a filtering device to prevent pulmonary embolism caused by thrombosis from lower limbs and pelvis. A new retrievable vena cava filter was evaluated in this paper. To evaluate the hemodynamic performance and thrombus capture efficiency after transplantation, numerical simulation of computational fluid dynamics was performed. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, filter wall shear stress, the ratio of area with wall shear stress, and the thrombus capture efficiency with the thrombus diameter of 5 mm, 10 mm, 15 mm and the thrombus content of 10%, 20%, 30%, respectively. Additionally, in vitro experimental test was performed to compare its thrombus capture efficiency with Denali and Aegisy Filters. The Denali Filter showed the least interference with the blood flow, followed by the new filter and the Aegisy Filter. The results indicated that the new filter had a higher capture rate in capturing 5mm small-diameter thrombus. This research certain theoretical significance and reference value for the research and development of the new vena cava filters as well as the evaluation of the thrombus capture efficiency of the filters.
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Affiliation(s)
- Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haoxiang Feng
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P.R. China
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2
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FENG HAIQUAN, WANG TIANQI, CHEN SIYUAN, WANG YONGGANG, WANG XIAOTIAN. STUDY ON THE NONLINEAR DEFORMATION MECHANICAL PROPERTIES OF A NEW TYPE OF VENA CAVA FILTER. J MECH MED BIOL 2022. [DOI: 10.1142/s021951942250035x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to analyze the mechanical properties of a new type of retrievable vena cava filter, the Denali and Aeginsy retrievable filters are selected, and the in vivo and in vitro mechanical properties of the three types of retrievable vena cava filters are compared. The nonlinear deformation process of the filter which is pressed into the transport sheath, flicked and released into the vascular vessel is simulated by using the finite element method, and the mechanical behaviors of the filter and the blood vessel wall are analyzed. During the crimping process, the elastic strain peak value of the filter wall increases with increasing amount of grip. The maximum elastic strain peak value of the three filters is less than 8%, and the safety factor is greater than 2, which meets the strength requirement. Equivalent stress and strain on the vascular wall decreases along the direction of blood flow after the filter is opened. The peak value of equivalent stress and strain on the vascular wall corresponding to Aegisy filter is the largest, and the impact on the vascular wall is the largest. The total displacement of the three filters under the action of thrombus and blood fluids is not more than 80[Formula: see text][Formula: see text]m. The impact of the new filter on the vascular wall is smaller than that of Aegisy filter, and the total displacement after implantation is smaller than that of Denali filter. The results are valuable for the evaluation and clinical application of the new vena cava filter.
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Affiliation(s)
- HAIQUAN FENG
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
| | - TIANQI WANG
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
| | - SIYUAN CHEN
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
| | - YONGGANG WANG
- Suzhou Venmed Technology Co., Ltd., Suzhou 215000, P. R. China
| | - XIAOTIAN WANG
- The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, P. R. China
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3
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Patel R, Ahuja A, Resnick S. Percutaneous retrieval of a Mobin-Uddin inferior vena cava filter 42 years following implantation. Diagn Interv Radiol 2021; 27:792-795. [PMID: 34792036 PMCID: PMC8621636 DOI: 10.5152/dir.2021.20984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/15/2020] [Accepted: 01/02/2021] [Indexed: 06/13/2023]
Abstract
Inferior vena cava filters (IVCFs) are an established alternative for protection from thromboembolism when anticoagulation fails or is contraindicated. Before the creation of retrievable IVCFs, patients received filters that were permanent or designed without standardized retrieval options. Although these filters were implanted for prolonged protection, chronic vena caval occlusion and post-thrombotic syndrome are potential sequelae. We present a 53-year-old patient with a Mobin-Uddin permanent IVCF placed 42 years prior complicated by acute iliocaval thrombosis following more than 40 years of filter dwell time. She was successfully treated with thrombolysis, thrombectomy, endobronchial forceps assisted IVCF removal, and iliocaval stent reconstruction.
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Affiliation(s)
- Ricky Patel
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois, US
| | - Arjun Ahuja
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, US
| | - Scott Resnick
- Department of Radiology, Division of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois, US
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Wang J, Huang W, Zhou Y, Han F, Ke D, Lee C. Hemodynamic Analysis of VenaTech Convertible Vena Cava Filter Using Computational Fluid Dynamics. Front Bioeng Biotechnol 2020; 8:556110. [PMID: 33195121 PMCID: PMC7661937 DOI: 10.3389/fbioe.2020.556110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
The VenaTech convertible filter (VTCF) has been widely used as an inferior vena cava (IVC) filter to prevent fatal pulmonary embolism in patients. However, its hemodynamics that greatly affect the filter efficacy and IVC patency are still unclear. This paper uses computational fluid dynamics with the Carreau model to simulate the non-Newtonian blood flows around the VTCF respectively deployed in the normal, reverse and three converted states in an IVC model. The results show that the prothrombotic stagnation zones are observed downstream from the normal, reverse and small open VTCFs, with the streamwise length is nearly eight times the IVC diameter. The no-slip boundary conditions of the thin-wire VTCF arms lead to the “viscous block” effect. The viscous block accelerates the blood flow by 5–15% inside the IVC and enhances the filter wall shear stress up to nearly 20 times that of the IVC only, which contributes to clot capture and thrombus lysis. The relative flow resistance is defined to evaluate the filter-induced resistance on the IVC blood flow that can be regarded as an index of IVC patency with the filter deployment. The flow resistance of the normal VTCF deployment increases dramatically by more than 60% compared with that of the IVC only and is a little higher (6%) than that of the reverse case. As the VTCF converts to a fully open configuration, the flow resistance gradually decreases to that of no filter. This work shows that even very thin VTCF arms can result in the viscous block effect and may cause significant hemodynamic impacts on clot capture, potential thrombosis and flow impedance inside the IVC. The present study also shows that CFD is a valuable and feasible in silico tool for analyzing the IVC filter hemodynamics to complement in vivo clinical and in vitro experimental studies.
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Affiliation(s)
- Jingying Wang
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Wen Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Zhou
- School of Aeronautical Science and Engineering, Beihang University, Beijing, China
| | - Fangzhou Han
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Dong Ke
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunhian Lee
- School of Energy and Power Engineering, Shandong University, Jinan, China.,School of Aeronautical Science and Engineering, Beihang University, Beijing, China
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5
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López JM, Fortuny G, Puigjaner D, Herrero J, Marimon F. Hemodynamic effects of blood clots trapped by an inferior vena cava filter. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3343. [PMID: 32323487 DOI: 10.1002/cnm.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient-specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm3 , were considered. A non-Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three-equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem.
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Affiliation(s)
- Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Francesc Marimon
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Catalunya, Spain
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6
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Ahmed O, Livshits I, Van Ha T. Endovascular Forceps-Assisted Removal of a Mobin-Uddin Filter Complicated by Aortic Strut Penetration and Chronic Filter-Related Inferior Vena Cava Thrombosis. J Vasc Interv Radiol 2020; 31:1197-1199. [PMID: 32534973 DOI: 10.1016/j.jvir.2020.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637
| | - Ilya Livshits
- Department of Radiology, Section of Interventional Radiology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637
| | - Thuong Van Ha
- Department of Radiology, Section of Interventional Radiology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637
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7
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Outcomes of the TrapEase inferior vena cava filter over 10 years at a single health care system. J Vasc Surg Venous Lymphat Disord 2018; 6:599-605. [DOI: 10.1016/j.jvsv.2018.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
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8
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An experimental and computational study of the inferior vena cava hemodynamics under respiratory-induced collapse of the infrarenal IVC. Med Eng Phys 2018; 54:44-55. [DOI: 10.1016/j.medengphy.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/30/2017] [Accepted: 02/11/2018] [Indexed: 12/27/2022]
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9
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FENG HAIQUAN, WANG KUN, QIU HONGRAN, WANG DONG. RESEARCH ON BIOMECHANICS PROPERTIES AND HEMODYNAMICS PERFORMANCE OF THE CONVERTIBLE VENA CAVA FILTER. J MECH MED BIOL 2017. [DOI: 10.1142/s021951941740022x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper reveals the biomechanical properties and hemodynamics performance of the convertible vena cava filter while it was in the process of implantation and conversion in the blood vessels. This paper uses the finite element method and computational fluid dynamics to analyze the interaction mechanism and influence of the convertible vena cava filter while the filter was in the process of implantation and conversion in the blood vessels. Additionally, six pigs were used as experimental samples to verify the effects of the filter in the blood vessels. The computer-aided simulation results showed that it was easier to cause damage to the vessel wall prior to the filter being converted into support. On the contrary, the stress, the peak value of the blood vessel’s stress, the outlet velocity, and the supporting stiffness were reduced after the conversion. Due to the intimal hyperplasia, the supporting element was easy to fix on the inner surface of the blood vessels, which was helpful for the correct positioning of the filter after the conversion. Meanwhile, the animal experiments proved that the surface of inferior vena cava wall was relatively smooth, and the filter did not cause vascular wall rupture. The computer-aided simulation and animal experiments proved the reasonability of the structure of the filter design, and that the filter has good biomechanical properties. The results will provide more scientific reference for the clinical treatment and design of the filter.
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Affiliation(s)
- HAIQUAN FENG
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
| | - KUN WANG
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
| | - HONGRAN QIU
- Lepu Medical Technology (Beijing) Co., Ltd., Beijing 102200, P. R. China
| | - DONG WANG
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, P. R. China
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10
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Andreoli JM, Thornburg BG, Hickey RM. Inferior Vena Cava Filter-Related Thrombus/Deep Vein Thrombosis: Data and Management. Semin Intervent Radiol 2016; 33:101-4. [PMID: 27247478 DOI: 10.1055/s-0036-1581087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recurrent deep venous thrombosis and inferior vena cava (IVC) thrombosis are well-described complications following IVC filter placement. IVC thrombosis ranges in severity of clinical presentation, but can lead to significant morbidity and mortality with incidence rates depending on patient population and type of filter used. Endovascular therapies such as catheter-directed thrombolysis, mechanical thrombectomy, balloon venoplasty, and stenting are safe and effective in restoration of venous patency.
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Affiliation(s)
- Jessica M Andreoli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bartley G Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ryan M Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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11
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Nicolás M, Peña E, Malvè M, Martínez M. Mathematical modeling of the fibrosis process in the implantation of inferior vena cava filters. J Theor Biol 2015; 387:228-40. [DOI: 10.1016/j.jtbi.2015.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/13/2015] [Accepted: 09/17/2015] [Indexed: 11/26/2022]
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12
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Konishi H, Miyoshi T, Neki R, Fukuda T, Ishibashi-Ueda H, Ogo T, Nakanishi N, Yoshimatsu J. Intrapartum temporary inferior vena cava filters are rarely indicated in pregnant women with deep venous thromboses. J Vasc Surg Venous Lymphat Disord 2015; 3:370-375. [DOI: 10.1016/j.jvsv.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022]
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13
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In vitro comparison of Günther Tulip and Celect filters. Testing filtering efficiency and pressure drop. J Biomech 2015; 48:504-11. [DOI: 10.1016/j.jbiomech.2014.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/03/2014] [Accepted: 11/28/2014] [Indexed: 11/22/2022]
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Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 2:274-81. [DOI: 10.1016/j.jvsv.2013.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/02/2013] [Accepted: 12/22/2013] [Indexed: 11/19/2022]
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15
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Aycock KI, Campbell RL, Manning KB, Sastry SP, Shontz SM, Lynch FC, Craven BA. A Computational Method for Predicting Inferior Vena Cava Filter Performance on a Patient-Specific Basis. J Biomech Eng 2014; 136:1870705. [DOI: 10.1115/1.4027612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 05/08/2014] [Indexed: 12/19/2022]
Abstract
A computational methodology for simulating virtual inferior vena cava (IVC) filter placement and IVC hemodynamics was developed and demonstrated in two patient-specific IVC geometries: a left-sided IVC and an IVC with a retroaortic left renal vein. An inverse analysis was performed to obtain the approximate in vivo stress state for each patient vein using nonlinear finite element analysis (FEA). Contact modeling was then used to simulate IVC filter placement. Contact area, contact normal force, and maximum vein displacements were higher in the retroaortic IVC than in the left-sided IVC (144 mm2, 0.47 N, and 1.49 mm versus 68 mm2, 0.22 N, and 1.01 mm, respectively). Hemodynamics were simulated using computational fluid dynamics (CFD), with four cases for each patient-specific vein: (1) IVC only, (2) IVC with a placed filter, (3) IVC with a placed filter and model embolus, all at resting flow conditions, and (4) IVC with a placed filter and model embolus at exercise flow conditions. Significant hemodynamic differences were observed between the two patient IVCs, with the development of a right-sided jet, larger flow recirculation regions, and lower maximum flow velocities in the left-sided IVC. These results support further investigation of IVC filter placement and hemodynamics on a patient-specific basis.
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Affiliation(s)
- Kenneth I. Aycock
- Department of Bioengineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802 e-mail:
| | - Robert L. Campbell
- Department of Mechanical and Nuclear Engineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802
| | - Keefe B. Manning
- Department of Bioengineering, The Pennsylvania State University, University Park, PA 16802
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Shankar P. Sastry
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112
| | - Suzanne M. Shontz
- Department of Mathematics and Statistics, Department of Computer Science and Engineering, Center for Computational Sciences, Graduate Program in Computational Engineering, Mississippi State University, Mississippi State, MS 39762
| | - Frank C. Lynch
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Brent A. Craven
- Department of Mechanical and Nuclear Engineering, Department of Bioengineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802 e-mail:
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16
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Darcy M. Error by distraction. Semin Intervent Radiol 2013; 29:337-40. [PMID: 24293808 DOI: 10.1055/s-0032-1330069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michael Darcy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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17
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Rajasekhar A, Streiff MB. Vena cava filters for management of venous thromboembolism: A clinical review. Blood Rev 2013; 27:225-41. [DOI: 10.1016/j.blre.2013.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Friedell ML, Nelson PR, Cheatham ML. Vena cava filter practices of a regional vascular surgery society. Ann Vasc Surg 2012; 26:630-5. [PMID: 22664279 DOI: 10.1016/j.avsg.2011.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/18/2011] [Accepted: 11/24/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Vena cava filter (VCF) use in the United States has increased dramatically with prophylactic indications for placement and the availability of low-profile retrievable devices, which are overtaking the filter market. We surveyed the practice patterns of a large group of vascular surgeons from a regional vascular surgery society to see whether they mirrored current national trends. METHODS A 17-question online VCF survey was offered to all members of the Southern Association of Vascular Surgery. The responses were analyzed using the χ(2) goodness of fit tests. RESULTS Of the 276 members surveyed, 126 (46%) responded, with 118 (93%) indicating that they placed filters during their practice. Highly significant differences were identified with each question (at least P < 0.002). Regarding the inferior vena cava, the preferred permanent filters were the Greenfield (31%), the TrapEase (15%), the Vena Tech (5%), and a variety of retrievable devices (49%). Fifty percent of the respondents placed retrievable filters selectively; 26% always placed them; and 24% never did. Filters were placed for prophylactic indications <50% of the time by 63% of the respondents. Overall, retrievable filters (when not used as permanent filters) were removed <25% of the time by 64% of the respondents and <50% of the time by 78% of the respondents. The femoral vein was the preferred access site for 84% of the respondents. Major complications were few but included filter migration to the atrium (one), atrial perforation (one), abdominal pain requiring surgical filter removal (two), inferior vena cava thrombosis (12 vena cava thrombosis--4 due to TrapEase filters), strut fracture with embolization to heart or lungs (three Bard retrievable filters), and severe tilting precluding percutaneous retrieval and protection from pulmonary emboli (8 filters with severe tilt--7 of which were Bard). Of the respondents, 59% had never placed a superior vena cava filter, and 28% had placed five or fewer. CONCLUSIONS Although VCF insertion overall appears safe, some complications are specific to biconical and certain retrievable filters. Given the low removal rate and lack of long-term experience with retrievable filters, routine use of these devices as permanent filters should be questioned. If used on a temporary basis, there should be a plan for filter removal at the time of implantation.
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Affiliation(s)
- Mark L Friedell
- Department of Surgical Education, Orlando Health, Orlando, FL, USA.
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20
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Comerota AJ. The Future of Deep Venous Thrombosis and Post-thrombotic Syndrome in 2020. Phlebology 2012; 27 Suppl 1:95-102. [DOI: 10.1258/phleb.2011.012s08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This manuscript addresses six major issues involving deep venous thrombosis (DVT) and post-thrombotic syndrome. Prevention will likely see modest advances in pharmacological therapy mainly by extending prophylaxis in high-risk patients. More notable advances will be observed in mechanical means of prophylaxis, focusing on sustained application of devices that can move larger volumes of blood. Silent, large-vein thrombi continue to place patients at risk for fatal pulmonary embolism. Improved imaging techniques will permit us to identify these patients over the next eight years. In many of those patients, vena caval interruption will be required. Elimination of high-risk filters and the production of improved filters placed through low-profile systems with antithrombotic agents bound to their surface will improve the short- and long-term results for inferior vena cava filters. The long-term management of DVT will focus on establishing appropriate duration for the individual patient and will see the evolution towards direct Xa and Ha inhibitors. Patients with extensive DVT will more commonly receive treatment strategies designed to eliminate thrombus and restore patency. This will substantially reduce post-thrombotic morbidity and reduce recurrence. Post-thrombotic syndrome will see greater attention towards treating the intraluminal fibrosis, thereby eliminating post-thrombotic venous obstruction. Unfortunately, neovalves will still be searching for the appropriate application.
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Affiliation(s)
- A J Comerota
- University of Michigan, Ann Arbor
- Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA
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21
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Modeling hemodynamics in an unoccluded and partially occluded inferior vena cava under rest and exercise conditions. Med Biol Eng Comput 2012; 50:277-87. [DOI: 10.1007/s11517-012-0867-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 02/06/2012] [Indexed: 01/26/2023]
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22
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Habito CR, Kalva SP. Inferior vena cava filter thrombosis: a review of current concepts, evidence, and approach to management. Hosp Pract (1995) 2011; 39:79-86. [PMID: 21881395 DOI: 10.3810/hp.2011.08.583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The increased risk of venous thrombosis within and below the inferior vena cava (IVC) is the main long-term complication of IVC filter placement. In this article, we discuss current concepts regarding the incidence, risks, and management of IVC filter thrombosis. Evidence of the association of each of the following factors is reviewed: type and design of the filter device, population demographics, underlying hypercoagulable states/anticoagulation, modality used to assess for thrombosis, and length of time elapsed since filter placement. Certain double-basket filter designs and a hypercoagulable state are associated with increased incidence of IVC filter thrombosis. Most cases of IVC filter thrombosis are asymptomatic. While large series data on the use of magnetic resonance imaging for the detection of filter thrombosis remain unavailable, evidence suggests that contrast-enhanced computed tomography is preferable to Doppler sonography. A proposed algorithm for the management of IVC filter thrombosis is provided.
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Affiliation(s)
- Cicero R Habito
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Rahbar E, Mori D, Moore JE. Three-dimensional Analysis of Flow Disturbances Caused by Clots in Inferior Vena Cava Filters. J Vasc Interv Radiol 2011; 22:835-42. [DOI: 10.1016/j.jvir.2010.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 04/07/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022] Open
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Singer MA, Wang SL. Modeling Blood Flow in a Tilted Inferior Vena Cava Filter: Does Tilt Adversely Affect Hemodynamics? J Vasc Interv Radiol 2011; 22:229-35. [DOI: 10.1016/j.jvir.2010.09.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 09/12/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022] Open
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Singer MA, Wang SL, Diachin DP. Design Optimization of Vena Cava Filters: An Application to Dual Filtration Devices. J Biomech Eng 2010; 132:101006. [DOI: 10.1115/1.4002488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulmonary embolism (PE) is a significant medical problem that results in over 300,000 fatalities per year. A common preventative treatment for PE is the insertion of a metallic filter into the inferior vena cava that traps thrombi before they reach the lungs. The goal of this work is to use methods of mathematical modeling and design optimization to determine the configuration of trapped thrombi that minimizes the hemodynamic disruption. The resulting configuration has implications for constructing an optimally designed vena cava filter. Computational fluid dynamics is coupled with a nonlinear optimization algorithm to determine the optimal configuration of a trapped model thrombus in the inferior vena cava. The location and shape of the thrombus are parametrized, and an objective function, based on wall shear stresses, determines the worthiness of a given configuration. The methods are fully automated and demonstrate the capabilities of a design optimization framework that is broadly applicable. Changes to thrombus location and shape alter the velocity contours and wall shear stress profiles significantly. For vena cava filters that trap two thrombi simultaneously, the undesirable flow dynamics past one thrombus can be mitigated by leveraging the flow past the other thrombus. Streamlining the shape of the thrombus trapped along the cava wall reduces the disruption to the flow but increases the area exposed to low wall shear stress. Computer-based design optimization is a useful tool for developing vena cava filters. Characterizing and parametrizing the design requirements and constraints is essential for constructing devices that address clinical complications. In addition, formulating a well-defined objective function that quantifies clinical risks and benefits is needed for designing devices that are clinically viable.
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Affiliation(s)
- Michael A. Singer
- Center for Applied Scientific Computing, Lawrence Livermore National Laboratory, Livermore, CA 94551
| | - Stephen L. Wang
- Division of Vascular and Interventional Radiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA 95051
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Kalva SP, Marentis TC, Yeddula K, Somarouthu B, Wicky S, Stecker MS. Long-Term Safety and Effectiveness of the “OptEase” Vena Cava Filter. Cardiovasc Intervent Radiol 2010; 34:331-7. [DOI: 10.1007/s00270-010-9969-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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Usoh F, Hingorani A, Ascher E, Shiferson A, Patel N, Gopal K, Marks N, Jacob T. Prospective randomized study comparing the clinical outcomes between inferior vena cava Greenfield and TrapEase filters. J Vasc Surg 2010; 52:394-9. [DOI: 10.1016/j.jvs.2010.02.280] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 11/29/2022]
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Nazzal M, Chan E, Nazzal M, Abbas J, Erikson G, Sediqe S, Gohara S. Complications Related to Inferior Vena Cava Filters: A Single-Center Experience. Ann Vasc Surg 2010; 24:480-6. [DOI: 10.1016/j.avsg.2009.07.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 07/02/2009] [Accepted: 07/27/2009] [Indexed: 11/30/2022]
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Wang SL, Singer MA. Toward an Optimal Position for Inferior Vena Cava Filters: Computational Modeling of the Impact of Renal Vein Inflow with Celect and TrapEase Filters. J Vasc Interv Radiol 2010; 21:367-74; quiz 374. [DOI: 10.1016/j.jvir.2009.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 10/28/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022] Open
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Hajduk B, Tomkowski WZ, Malek G, Davidson BL. Vena cava filter occlusion and venous thromboembolism risk in persistently anticoagulated patients: a prospective, observational cohort study. Chest 2009; 137:877-82. [PMID: 19880907 DOI: 10.1378/chest.09-1533] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Inferior vena cava (IVC) filter placement may be life-saving, but after contraindications to anticoagulation remit, patient management is uncertain. METHODS We followed patients who had venous thromboembolism, followed by treatment with permanent IVC filter placement, and were anticoagulated long-term as soon as safety allowed. We conducted annual physical examinations and ultrasound surveillance of the lower extremity deep veins and of the IVC filter site. Clot detected at the filter site was treated with graded intensities of anticoagulation, depending on the clot burden. RESULTS Symptomatic DVT occurred in 24 of 121 patients (20%; 95% CI, 14%-28%); symptomatic pulmonary embolism (one fatal) was diagnosed in six patients (5%; 95% CI, 2%-10%). There were 45 episodes of filter clot in 36 patients (30%; 95% CI, 22%-38%). The rate of major bleeding (6.6%) was similar to that of a concurrent persistently anticoagulated cohort without IVC filters (5.8%). CONCLUSIONS If therapeutic anticoagulation can be safely begun in patients with IVC filters inserted after venous thromboembolism, further management with clinical surveillance, including ultrasound examination of the IVC filter and graded degrees of anticoagulation therapy if filter clot is detected, has a favorable prognosis. This approach appears valid for patients with current IVC filter and can serve as a comparison standard in subsequent clinical trials to optimize clinical management of these patients.
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Affiliation(s)
- Bogdan Hajduk
- Department of Internal Medicine, The National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Płocka 26, Poland.
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Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter. Cardiovasc Intervent Radiol 2009; 33:285-9. [DOI: 10.1007/s00270-009-9664-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 06/16/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
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Singer MA, Henshaw WD, Wang SL. Computational Modeling of Blood Flow in the TrapEase Inferior Vena Cava Filter. J Vasc Interv Radiol 2009; 20:799-805. [DOI: 10.1016/j.jvir.2009.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 01/31/2009] [Accepted: 02/04/2009] [Indexed: 11/24/2022] Open
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Stewart SFC, Robinson RA, Nelson RA, Malinauskas RA. Effects of Thrombosed Vena Cava Filters on Blood Flow: Flow Visualization and Numerical Modeling. Ann Biomed Eng 2008; 36:1764-81. [DOI: 10.1007/s10439-008-9560-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
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Proctor MC, Greenfield LJ. Form And Function Of Vena Cava Filters: How Do Optional Filters Measure Up? Vascular 2008; 16:10-6. [DOI: 10.2310/6670.2008.00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The function of vena cava filters, preventing pulmonary embolism while maintaining caval patency, is associated with the design. Several characteristics have been reported. This report evaluates retrievable filter designs in comparison with previously marketed designs with respect to efficacy and safety. Three inferior vena cava (IVC) filters (Gunther Tulip, Bard Recovery, and the Cordis OptEase) were compared on the basis of design characteristics associated with function, shape, number of trapping levels, and fixation. Adverse events reported in the literature and to the US Food and Drug Administration Manufacturers and User Facility Device Experience Database (MAUDE) were summarized. The major differences among device types include the fixation, the volume and number of trapping levels, and the amount of metal in the IVC. The MAUDE registry reported adverse events that had been hypothesized from the analysis of in vitro and in vivo testing. The Recovery and OptEase filters had the highest number of clinically important reports. From 12 to 57% were retrieved between 3 days and 11 months. Adaptations made to facilitate retrieval led to unacceptable sequelae. The small number removed, the length of time they are left in place, and the risks associated with retrieval suggest that optional filters may not be equivalent to approved permanent devices.
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Affiliation(s)
- Mary C. Proctor
- *Department of Surgery, University of Michigan, Ann Arbor, MI
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Shmuter Z, Frederic FI, Gill JR. Fatal migration of vena caval filters. Forensic Sci Med Pathol 2007; 4:116-21. [DOI: 10.1007/s12024-007-9001-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2007] [Indexed: 10/22/2022]
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