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Swersky A, Desai KR. Inferior Vena Cava Filter Retrieval: Simple to Complex. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03673-5. [PMID: 38396083 DOI: 10.1007/s00270-024-03673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Retrievable inferior vena cava filters were designed to provide mechanical prophylaxis from pulmonary embolism with the intent for retrieval once no longer indicated, and have been utilized at a high rate since their introduction. Unfortunately, retrieval rates have historically lagged behind, in part due to significant rates of failed standard retrieval techniques for filters with prolonged dwell time. Refinement in advanced retrieval techniques has now allowed (in experienced centers) for safe removal of filters previously considered irretrievable. An individualized approach is necessary for each potential advanced filter retrieval to determine appropriate course of action. This review will emphasize complex filter retrieval techniques amidst a larger discussion of inferior vena cava filters and their management.
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Affiliation(s)
- Adam Swersky
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 800, Chicago, IL, 60611, US
| | - Kush R Desai
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 800, Chicago, IL, 60611, US.
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2
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Zhou V, Reddick M, Lamus D, Arellano RS, Kalva SP. A Simple "Involute" Technique for Successful Removal of a Caudally Migrated "Viatorr" Stent Graft. Semin Intervent Radiol 2024; 41:92-96. [PMID: 38495265 PMCID: PMC10940037 DOI: 10.1055/s-0044-1779710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Vellia Zhou
- Tufts University School of Medicine, Boston, Massachusetts
| | - Mark Reddick
- Radiology Associates of the Fox Valley, Neenah, Wisconsin
| | - Daniel Lamus
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ronald S. Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjeeva P. Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Samuel M, Nahab B, Chadalavada S. Balloon-Assisted Retrieval of a Retained Vascular Sheath during Complex Inferior Vena Cava Filter Removal. Semin Intervent Radiol 2023; 40:298-303. [PMID: 37484446 PMCID: PMC10359118 DOI: 10.1055/s-0043-1769747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
A potential complication of complex endovascular procedures is retained foreign bodies such as fragmented catheters, wires, stents, or sheaths in the intravascular space. Different techniques are available for retrieval of intravascular foreign bodies including snares, forceps, baskets, tip-deflecting wires, and balloon catheters. The aim of this article is to describe our experience in which a lost large intravascular sheath was retrieved using balloon assistance. We also provide a review of different techniques used for intravascular large sheath retrieval and methods to avoid this complication during endovascular procedures such as complex inferior vena cava filter removal.
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Affiliation(s)
- Michael Samuel
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Bashar Nahab
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Seetharam Chadalavada
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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4
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Serrano E, Vila-Trias E, Zarco F, Zamora Martínez C, Moisés J, Gómez FM, López-Rueda A. Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables. RADIOLOGIA 2023; 65:230-238. [PMID: 37268365 DOI: 10.1016/j.rxeng.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.
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Affiliation(s)
- E Serrano
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - E Vila-Trias
- Servicio Radiología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - F Zarco
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - J Moisés
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - F M Gómez
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
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Abstract
The use of retrievable inferior vena cava filters is on the rise, but there is an inadequate number of these filters being removed even if their use as a prophylactic for venous thromboembolism is no longer indicated. Complications with retrievable filters that remain in the patient for an extended duration include examples such as filter tilt and embedding into the caval wall. This raises concerns for whether the filter is properly functioning and for consequent sequelae, including recurrent thrombosis, stenosis, or inferior vena cava perforation. With these complications, there are also challenges to retrieving these filters via the standard techniques and thus more advanced techniques are required. Both standard and advanced techniques, their uses, and possible risks of these methods are also discussed.
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Affiliation(s)
- Chan W Kim
- From the Division of Vascular Surgery, and the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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6
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Zhong A, Trerotola SO, Stavropoulos SW. Endobronchial Forceps Retrieval of Embedded Inferior Vena Cava Filters: Retrieval of 535 Filters at a Single Center. J Vasc Interv Radiol 2022; 34:529-533. [PMID: 36509239 DOI: 10.1016/j.jvir.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report results of 16 years of using the endobronchial forceps technique to remove embedded inferior vena cava (IVC) filters. MATERIALS AND METHODS Between January 2005 and June 2021, 534 patients (310 women and 224 men) with a mean age of 52 years (standard deviation [SD] ± 16 years) presented for complex filter retrieval of 535 tip- or strut-embedded IVC filters. Tip-embedded filters were diagnosed on rotational venography. Filters were considered strut-embedded if they were closed-cell filters with dwell times of >6 months. The filter was dissected from the IVC using rigid bronchoscopy forceps and removed through a vascular sheath. RESULTS The endobronchial forceps technique was successful in 530 of 537 retrieval attempts on an intention-to-treat basis (98.7%); a total of 530 filters were retrieved. There were 7 failures: (a) 5 failed retrieval attempts (2 that were retrieved successfully in subsequent procedures) and (b) 2 for which retrieval was not attempted. The mean filter dwell time was 1,459 days (SD ± 1,617 days). Laser sheaths were not used for any removal. Filters included herein were 137 Celect (94 Celect and 43 Celect Platinum), 99 Günther Tulip, 72 Option (48 Option and 24 Option Elite), 68 G2, 45 G2X/Eclipse, 42 Denali, 30 OptEase, 29 Recovery, 7 Meridian, and 6 ALN with Hook filters. Thirty-four minor (6.3%) and 11 major (2%) adverse events (AEs) occurred, which did not result in permanent sequelae. CONCLUSIONS Use of endobronchial forceps for removal of tip- and strut-embedded retrievable IVC filters is effective and has low AE rates.
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Affiliation(s)
- Anny Zhong
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Desai KR, Kaufman J, Truong P, Lindquist JD, Ahmed O, Flanagan SM, Garcia MJ, Ram R, Gao YR, Lewandowski RJ, Ryu RK. Safety and Success Rates of Excimer Laser Sheath-Assisted Retrieval of Embedded Inferior Vena Cava Filters. JAMA Netw Open 2022; 5:e2248159. [PMID: 36542378 PMCID: PMC9856719 DOI: 10.1001/jamanetworkopen.2022.48159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Despite historically high rates of use, most inferior vena cava (IVC) filters are not retrieved. The US Food and Drug Administration safety communications recommended retrieval when the IVC filter is no longer indicated out of concern for filter-related complications. However, failure rates are high when using standard techniques for retrieval of long-dwelling filters, and until recently, there have been no devices approved for retrieval of embedded IVC filters. OBJECTIVE To evaluate the safety and success of excimer laser sheath-assisted retrieval of embedded IVC filters. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, clinical cohort study of excimer laser sheath-assisted IVC filter retrievals from 7 US sites was conducted between March 1, 2012, and February 28, 2021, among 265 patients who underwent IVC filter retrieval using the laser. Patients were substratified between a high-volume single center and a multicenter data set. A blinded physician committee adjudicated reported complications and their association with use of the laser. EXPOSURES Retrieval of IVC filters using excimer laser sheath. MAIN OUTCOMES AND MEASURES The primary safety end point was device-related major complication rate (Society of Interventional Radiology categories C to F, which included any adverse event associated with morbidity or disability that increases the level of care, results in hospital admission, or substantially lengthens the hospital stay). The primary success end point was technical success of IVC filter retrieval. The primary end points were compared with literature-derived, meta-analysis-suggested target performance goals. RESULTS The single-center experience included 139 participants (mean [SD] age, 52 [16] years; 78 female participants [56.1%]), and the multicenter experience included 126 participants (mean [SD] age, 52 [16] years; 75 female participants [59.5%]). The device-related major complication rate was 2.9% (4 of 139; 95% CI, 0.8%-7.2%; P = .001) for the single-center experience and 4.0% (5 of 126; 95% CI, 1.3%-9.0%; P = .01) for the multicenter experience, both of which were significantly lower than the primary safety performance goal (10%). No major complications were considered to be definitively associated with use of the laser. The technical success rate was 95.7% (133 of 139; 95% CI, 90.8%-98.4%; P = .007) for the single-center experience and 95.2% (120 of 126; 95% CI, 89.9%-98.2%; P = .02) for the multicenter experience, both of which were significantly higher than the primary performance goal (89.4%). CONCLUSIONS AND RELEVANCE This cohort study demonstrated high technical success and low complication rates of excimer laser sheath-assisted retrieval of embedded IVC filters in centers with variable case volume and experience, which suggests a wide applicability of the technique with proper training. The excimer laser sheath offers physicians a valuable tool for retrieval of challenging embedded IVC filters.
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Affiliation(s)
- Kush R. Desai
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - John Kaufman
- Department of Interventional Radiology, Oregon Health & Science University, Portland
| | - Parker Truong
- Department of Interventional Radiology, Oklahoma Heart Hospital, Oklahoma City
| | - Jonathan D. Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Osman Ahmed
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Siobhan M. Flanagan
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Minnesota Medical Center, Minneapolis
| | - Mark J. Garcia
- EndoVascular Consultants, Wilmington, Delaware
- Department of Radiology, Trinity Health, Saint Francis Healthcare, Wilmington, Delaware
| | - Rashmi Ram
- Department of Clinical & Medical Affairs, Philips North America LLC, Cambridge, Massachusetts
| | - Yu-Rong Gao
- Department of Clinical & Medical Affairs, Philips North America LLC, Cambridge, Massachusetts
| | | | - Robert K. Ryu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles
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Matsushita M, Takano M, Miyauchi Y. Device for retrieval of vena cava filter with combination of a multi-loop snare and Amplatz catheter. SAGE Open Med Case Rep 2022; 10:2050313X221086102. [PMID: 35341096 PMCID: PMC8943558 DOI: 10.1177/2050313x221086102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 02/20/2022] [Indexed: 11/17/2022] Open
Abstract
A 25-year-old woman diagnosed as having a non-massive pulmonary embolism and deep vein
thrombosis from the right superficial femoral to the right common iliac vein was treated
by deployment of a DENALI® Vena Cava Filter. Filter retrieval was attempted
6 months later using a BARD snare retrieval kit. However, the conventional technique was
unsuccessful because of a tilt and attachment of the filter head to the vessel wall.
Hence, we passed an EN Snare Endovascular Snare System through an Amplatz Left 1 guiding
catheter to successfully penetrate the attached portion of the filter hook and vessel
wall. This combination provided controlled direction and a strong backup force that helped
capture and retrieve the filter. This technique could be an alternative method to retrieve
inferior vena cava filter with severe tilt and tight attachment to the vena cava wall when
the conventional technique is unsuccessful.
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Affiliation(s)
- Masato Matsushita
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Japan
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Japan
| | - Yasushi Miyauchi
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Japan
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Rezaei-Kalantari K, Rotzinger DC, Qanadli SD. Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up. Front Cardiovasc Med 2022; 9:746748. [PMID: 35310979 PMCID: PMC8927289 DOI: 10.3389/fcvm.2022.746748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Mortality rates associated with venous thromboembolism (VTE) are high. Inferior vena cava filters (IVCFs) have been frequently placed for these patients as part of their treatment, albeit the paucity of data showing their ultimate efficacy and potential risk of complications. Issues regarding long-term filter dwell time are accounted for in society guidelines. This topic has led to an FDA mandate for filter retrieved as soon as protection from pulmonary embolism is no longer needed. However, even though most are retrievable, some were inadvertently left as permanent, which carries an incremental lifetime risk to the patient. In the past decade, attempts have aimed to determine the optimal time interval during which filter needs to be removed. In addition, distinct strategies have been implemented to boost retrieval rates. This review discusses current conflicts in indications, the not uncommon complications, the rationale and need for timely retrieval, and different quality improvement strategies to fulfill this aim.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Yao S, Li Y, Zhu F, Guan S, Ge X, Ci H. Biopsy Forceps-Assisted Loop Snare Technique for Complex Retrieval of Inferior Vena Cava Filter. Vasc Endovascular Surg 2022; 56:424-427. [PMID: 35171744 DOI: 10.1177/15385744211069052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Severe tilt with embedded hooks is a common obstacle to successful inferior vena cava (IVC) filter retrieval. We present a case for which the biopsy forceps-assisted loop snare technique was successfully used to retrieve filters with hooks embedded in the IVC wall for which conventional retrieval failed. The technique is effective and provides a less-invasive, low-cost method for the complex retrieval of IVC filters.
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Affiliation(s)
- Sicheng Yao
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Yangyang Li
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Feng Zhu
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Sheng Guan
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Xiaohu Ge
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Hongbo Ci
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
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Merritt T, Powell C, Hansmann J. Safety and Effectiveness of Advanced Retrieval Techniques for Inferior Vena Cava Filters Compared to Standard Retrieval Techniques: A Systematic Review of the Literature and Meta-Analysis. J Vasc Interv Radiol 2022; 33:564-571.e4. [DOI: 10.1016/j.jvir.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022] Open
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Leite TFDO, Pazinato LV, Bortolini E, Pereira OI, Nomura CH, Filho JMDML. Endovascular removal of intravascular foreign bodies: A single-center experience and literature review. Ann Vasc Surg 2021; 82:362-376. [PMID: 34936892 DOI: 10.1016/j.avsg.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review. METHODS This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least five patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares. RESULTS The retrieval process rate was 100%. Thirty-one port-a-caths, six guidewires, four double lumens, three permcaths, three Shiley® catheters, one intra cath, two peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30-day mortality rate was zero. CONCLUSION Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.
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Affiliation(s)
| | - Lucas Vatanabe Pazinato
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edgar Bortolini
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Osvaldo Ignacio Pereira
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Cesar Higa Nomura
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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13
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Zhou M, Qi L, Gu Y. Successful retrieval of dislocated inferior vena cava filter using double vascular sheaths docking technology: case report. Thromb J 2021; 19:56. [PMID: 34404429 PMCID: PMC8371774 DOI: 10.1186/s12959-021-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dislocation of inferior vena cava filter (IVCF) is a rare complication with potential IVC perforation and other life-threatening risks requiring early diagnosis and in-time retrieval. Most of dislocation IVCF in the past have been shelved or removed by open surgery. It is very difficult to retrieve the filters by interventional technology. CASE PRESENTATION Here we report a 49-year-old man suffering from dislocation of IVCF implanted due to deep vein thrombosis (DVT) in the right femoral vein. Successful retrieval of the IVCF using double sheaths docking technique was done soon after confirmation of the dislocation. Importance of monitoring and early detection of dislocation of IVCF should be emphasized to avoid further complications. CONCLUSIONS The double vascular sheaths docking technique can be considered as a preferential option in difficult operative situation.
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Affiliation(s)
- Mi Zhou
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China
| | - Lixing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University , No. 45 Changchun Street, Xicheng District, 100053, Beijing, P. R. China.
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14
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Fujimori K, Okada A, Tabata H, Shoda M, Kuwahara K. Percutaneous Removal of a Displaced Inferior Vena Cava Filter Using a Loop-Wire Technique and Lead-Extraction Sheaths. Circ J 2021; 85:1403. [PMID: 34039833 DOI: 10.1253/circj.cj-21-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koki Fujimori
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine.,Department of Cardiology, Tokyo Women's Medical University
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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15
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Pillai A, Kathuria M, Bayona Molano MDP, Sutphin P, Kalva SP. An expert spotlight on inferior vena cava filters. Expert Rev Hematol 2021; 14:593-605. [PMID: 34139952 DOI: 10.1080/17474086.2021.1943350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Inferior vena cava (IVC) filters are mechanical filtration devices designed as an alternative to surgical ligation/plication of the IVC. Their use has been controversial, especially with the introduction of retrievable filters and expanded/prophylactic indications.Areas covered: Authors discuss the types of available IVC filters, indications for placement, evidence on their effectiveness in general and specific patient populations, procedural considerations, off-label use, complications, and filter retrieval. This review is based on manuscripts/abstracts published from 1960 to 2021 on venous thromboembolism and IVC filters.Expert opinion: Despite the limited data on their effectiveness and survival benefit, IVC filters continue to play an important role in the treatment of patients with venous thromboembolism (VTE) who cannot receive standard anticoagulation. There is no role of IVC filters in patients without VTE. While retrievable filters are desirable for short-term use, a dedicated team-based approach, and advanced training are required for their successful removal. Newer devices are promising in improving patient safety . The device manufacturers and regulatory agencies should consider specific approaches to track device-related adverse events. Population-based studies are required to establish optimal patient population who would benefit from these devices. .
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Affiliation(s)
- Anil Pillai
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manoj Kathuria
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Patrick Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wang H, Liu Z, Zhu X, Liu J, Man L. Retroperitoneal Laparoscopic-Assisted Retrieval of Wall-Penetrating Inferior Vena Cava Filter After Endovascular Techniques Failed: An Initial Clinical Outcome. Vasc Endovascular Surg 2021; 55:706-711. [PMID: 34080447 DOI: 10.1177/15385744211022517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed. PATIENTS AND METHODS We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months. RESULTS The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients' hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence. CONCLUSIONS Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.
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Affiliation(s)
- Haidong Wang
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Xiaofei Zhu
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Jianlong Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
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Percutaneous Retrieval of an Inferior Vena Cava Filter Penetrating Into the Duodenum. JACC Cardiovasc Interv 2021; 14:e131-e133. [PMID: 34052160 DOI: 10.1016/j.jcin.2021.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
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18
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Ochoa Chaar CI, Kostiuk V, Gholitabar N. The wire loop technique for IVC filter removal. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:369-370. [PMID: 34278059 PMCID: PMC8261545 DOI: 10.1016/j.jvscit.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
Inferior vena cava (IVC) filters are effective therapy to prevent pulmonary embolism in patients with contraindication to anticoagulation. However, IVC wall penetration by the filter struts is a common complication that can lead to symptoms specially when adjacent organs are impacted. This case report and video describe the wire loop technique for successful endovascular IVC filter retrieval in a patient with lower back pain caused by a spinal strut penetration. The patient's back pain resolved after filter retrieval and he remained stable on anticoagulation with no recurrence of venous thromboembolism.
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Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | | | - Navid Gholitabar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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19
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Ho RD. Furthering Trainee Education Through Simulating Complex IVC Filter Retrievals. Acad Radiol 2021; 28:439. [PMID: 32958430 DOI: 10.1016/j.acra.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
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20
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Desai KR, Xiao N, Salem R, Karp JK, Ryu RK, Lewandowski RJ. Excimer Laser Sheath-Assisted Retrieval of "Closed-Cell" Design Inferior Vena Cava Filters. J Am Heart Assoc 2020; 9:e017240. [PMID: 32815443 PMCID: PMC7660756 DOI: 10.1161/jaha.120.017240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Numerous reports have shown that inferior vena cava filters are associated with clinically significant adverse events. Complicating factors, such as caval incorporation, may lead to technical challenges at retrieval. The use of advanced techniques including the laser sheath have increased technical success rates; however, the data are limited on which filter types necessitate and benefit from its use. Methods and Results From October 2011 to September 2019, patients with inferior vena cava filter dwell times >6 months or with prior failed retrievals were considered for laser sheath-assisted retrieval. Standard and nonlaser advanced retrieval techniques were attempted first; if the filter could not be safely or successfully detached from the caval wall using these techniques, the laser sheath was used. Technical success, filter type, necessity for laser sheath application based on "open" versus "closed-cell" filter design, dwell times, and adverse events were evaluated. A total of 441 patients (216 men; mean age, 54 years) were encountered. Mean dwell times for all filters was 56.6 months, 54.4 among closed-cell filters and 58.5 among open-cell filters (P=0.63). Technical success of retrieval was 98%, with the laser sheath required in 143 cases (40%). Successful retrieval of closed-cell filters required laser sheath assistance in 60% of cases as compared with 7% of open-cell filters (odds ratio, 20.1; P<0.01). In closed-cell inferior vena cava filters, dwell time was significantly associated with need for laser, requiring it in 64% of retrievals with dwell times >6 months (P=0.01). One major adverse event occurred among laser sheath retrievals when a patient required a 2-day inpatient admission for a femoral access site hemorrhage. Conclusions Closed-cell filters may necessitate the use of the laser sheath for higher rates of successful and safe retrieval.
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Affiliation(s)
- Kush R Desai
- Department of Radiology Northwestern University Chicago IL
| | - Nicholas Xiao
- Department of Radiology Northwestern University Chicago IL
| | - Riad Salem
- Department of Radiology Northwestern University Chicago IL
| | | | - Robert K Ryu
- Department of Radiology University of Southern California Los Angeles CA
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21
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Quencer KB, Smith TA, Deipolyi A, Mojibian H, Ayyagari R, Latich I, Ali R. Procedural complications of inferior vena cava filter retrieval, an illustrated review. CVIR Endovasc 2020; 3:23. [PMID: 32337618 PMCID: PMC7184068 DOI: 10.1186/s42155-020-00113-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Annually, approximately 65,000 inferior vena cava (IVC) filters are placed in the United States (Ahmed et al., J Am Coll Radiol 15:1553-1557, 2018). Approximately 35% of filters are eventually retrieved (Angel et al., J Vasc Interv Radiol 22: 1522-1530 e1523, 2011). Complications during filter retrieval depend heavily on technique and filter position. In this paper, we review risk factors and incidence of complications during IVC filter removal. We also discuss ways these complications could be avoided and the appropriate management if they occur.
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Affiliation(s)
- Keith B Quencer
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA.
| | - Tyler A Smith
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA
| | - Amy Deipolyi
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering, New York, USA
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Raj Ayyagari
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Igor Latich
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Rahmat Ali
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
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22
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Moriarty HK, Marshall E, Clements W. A 7-year retrospective review of the technical success of the "low-profile" hangman technique for complicated inferior vena cava (IVC) filter retrievals. Diagn Interv Radiol 2020; 26:118-123. [PMID: 32071027 PMCID: PMC7051261 DOI: 10.5152/dir.2019.19223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/27/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the safety and effectiveness of a modified low-profile hangman technique. METHODS We performed a retrospective review of all filter retrieval procedures performed at a major trauma center, from 2012 to 2019. Records were reviewed for patient demographics, device type, device dwell time, device tilt, embedded hook, success of device retrieval, evidence of caval injury and occurrence of complications. RESULTS From 2012 to 2019 there were 473 filter retrieval attempts. An advanced technique was documented in 66 (14%). The low-profile hangman technique alone was documented in 23 procedures (5% of all procedures, 35% of advanced technique procedures). Average screening time was 28 minutes. At the time of retrieval attempt, 9 patients (41%) were anticoagulated. The hangman technique was employed as isolated maneuver in 23 patients and was successful on initial attempt in 22 cases (96%). The average dwell time of filters retrieved by the hangman technique was 228 days (range, 40-903 days; median, 196 days). No procedure-related complications occurred. CONCLUSION The retrieval of IVC filters is an important part of offering an IVC filter service. Advanced techniques to retrieve caval filters are multiple, and the risk of complications is increased in these cases. We demonstrate the safety and effectiveness of a new modified and lower-profile hangman technique. This new technique could be performed with only an 11 French venous access sheath using off-the-shelf equipment and it remains a cost-effective approach to complex filter retrieval.
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Affiliation(s)
- Heather Kate Moriarty
- From the Department of Radiology (H.K.M. , E.M., W.C.), Alfred Health, Melbourne, Australia; Department of Surgery (W.C.), Monash University, Clayton, Australia
| | - Elissa Marshall
- From the Department of Radiology (H.K.M. , E.M., W.C.), Alfred Health, Melbourne, Australia; Department of Surgery (W.C.), Monash University, Clayton, Australia
| | - Warren Clements
- From the Department of Radiology (H.K.M. , E.M., W.C.), Alfred Health, Melbourne, Australia; Department of Surgery (W.C.), Monash University, Clayton, Australia
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23
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Hayashi H, Tsuji A, Asano R, Konagai N, Ueda J, Fukui S, Ogo T, Miyata S, Yasuda S. Successful multi-step catheter intervention for thrombotic inferior vena cava filter retrieval. J Cardiol Cases 2020; 20:142-146. [PMID: 31969945 DOI: 10.1016/j.jccase.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/29/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Abstract
A 45-year-old man, who was implanted with an inferior vena cava (IVC) filter in his infrarenal IVC, had a complication of deep vein thrombosis (DVT) propagation from the IVC, beyond the IVC filter, to the right calf and left external iliac veins. The entire IVC filter was covered with a massive thrombus. We first decided to retrieve the IVC filter itself, which was suspected of causing metallic allergy. The thrombotic IVC filter was successfully retrieved using multi-step catheter intervention. To our knowledge, this is the first case report to describe successful multi-step catheter intervention for retrieval of an IVC filter covered with a massive thrombus. <Learning objectives: Inferior vena cava (IVC) filter thrombosis is one of the most serious IVC filter complications. It is difficult to retrieve the IVC filter covered with a massive thrombus. Multi-step catheter intervention technique may be useful to retrieve an IVC filter with thrombotic occlusion.>.
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Affiliation(s)
- Hiroya Hayashi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiro Tsuji
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryotaro Asano
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Nao Konagai
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jin Ueda
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigefumi Fukui
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Ogo
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigeki Miyata
- Department of Clinical Laboratory Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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24
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Schuchardt PA, Yasin JT, Davis RM, Tewari SO, Bhat AP. The role of an IVC filter retrieval clinic-A single center retrospective analysis. Indian J Radiol Imaging 2019; 29:391-396. [PMID: 31949341 PMCID: PMC6958892 DOI: 10.4103/ijri.ijri_258_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/05/2019] [Accepted: 10/12/2019] [Indexed: 11/09/2022] Open
Abstract
Background: Inferior vena cava (IVC) filter placement still plays an essential role in preventing pulmonary embolism (PE) in patients with contraindications to anticoagulant therapy. However, IVC filter placement does have long-term risks which may be mitigated by retrieving them as soon as clinically acceptable. A dedicated IVC filter clinic provides a potential means of assuring adequate follow-up and retrieval. Aim: To assess the efficacy of our Inferior vena cava (IVC) filter retrieval clinic at improving the rate of patient follow-up, effective filter management, and retrieval rates. Materials and Methods: During the period of August 2017 through July 2018, 70 IVC filters were placed at our institution, and these patients were automatically enrolled into our IVC filter retrieval clinic for quarterly follow-up. We retrospectively reviewed data including appropriateness for removal at 3 months, overall retrieval rates, removal technique(s) employed, and technical success. Results: 62.9% of the potentially retrievable filters were removed during the study period. The technical success of extraction, using a combination of standard and advanced techniques, was 91.7%. Overall, 15% of the patients were lost to follow-up. Conclusion: Our findings add to the growing body of literature to support the need for a robust IVC filter retrieval clinic to ensure adequate follow-up and timely retrieval of IVC filters.
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Affiliation(s)
- Philip A Schuchardt
- Department of Radiology, Section of Interventional Radiology, University of Missouri-Columbia, Columbia 65212, MO, USA
| | - Junaid T Yasin
- Department of Radiology, Section of Interventional Radiology, University of Missouri-Columbia, Columbia 65212, MO, USA
| | - Ryan M Davis
- Department of Radiology, Section of Interventional Radiology, University of Missouri-Columbia, Columbia 65212, MO, USA
| | - Sanjit O Tewari
- Department of Interventional Radiology, SUNY Upstate Medical University, Syracuse 13210, NY, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Interventional Radiology, University of Missouri-Columbia, Columbia 65212, MO, USA
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25
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Forceps-assisted Removal of Difficult-to-Retrieve Filters: Preliminary Results. Ann Vasc Surg 2019; 61:371-376. [PMID: 31394218 DOI: 10.1016/j.avsg.2019.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study is to retrospectively evaluate the safety and effectiveness of forceps-assisted removal of difficult-to-retrieve filters. METHODS Patients who underwent forceps-assisted removal of difficult-to-retrieve filters (filters that could not be successfully removed with the standard loop-snare technique) between February 2008 and February 2019 were included in this study. Patients underwent forceps-assisted filter removal either immediately after failed loop-snare removal (same procedure) or at a later time (separate procedure). Data regarding success rate, X-ray exposure time, and complications were recorded. RESULTS A total of 27 patients (14 men, 13 women; mean age 57.9 ± 12.6 years) were included in this study. The mean indwelling time of the filters was 10.9 ± 10.7 months. All filters were successfully removed. The mean X-ray exposure time was 25.9 ± 12.7 min (range 8-55) for all patients; the mean X-ray exposure times were 10.2 ± 2.3 min (range 8-14) for the 5 patients who underwent forceps-assisted filter removal in a separate procedure and 29.5 ± 11.2 min (range 15-55) for the 22 patients who underwent forceps-assisted filter removal immediately after failure of the loop-snare technique (P < 0.001). Two patients (8.3%) experienced extravasation of contrast material and needed no additional treatment. No major complications occurred. CONCLUSIONS Forceps-assisted filter retrieval can be used to safely and effectively remove difficult-to-retrieve filters.
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26
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Su Q, Ding X, Dong Z, Liu Y, Li G, Jiang J. A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil. Int Heart J 2019; 60:93-99. [PMID: 30518716 DOI: 10.1536/ihj.18-075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.
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Affiliation(s)
- Qingbo Su
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Zhaoru Dong
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Yang Liu
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Guangzhen Li
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital of Shandong University
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27
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von Stempel C, Hague J, Brookes J. Excimer laser assisted complex inferior vena cava filter retrieval: a single institution's experience over 6 years. Clin Radiol 2019; 74:79.e15-79.e20. [DOI: 10.1016/j.crad.2018.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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Najafi A, Koulia K, Aubert P, Binkert CA. Multi loop snare technique for difficult inferior vena cava filter retrievals. CVIR Endovasc 2018; 1:33. [PMID: 30652164 PMCID: PMC6319532 DOI: 10.1186/s42155-018-0042-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Use of optional vena cava filters has steadily increased. In the majority of cases removal is successful using standard techniques. In cases of tilting and migration of the filter however, more advanced techniques are necessary. The "loop-snare" technique has been described for such cases. Difficulties arise when the loop starts to slip around the legs and arms of the filter. New technique We present an improved loop-snare technique which allows to retrieve IVC filters when the simple loop-snare technique fails. We used additional loops, in one case one additional loop in another case two additional loops around the filter tip which allowed successful retrieval. The additional loops were created with a reversed shaped catheter. All guidewires were then engaged with a snare and pulled into a large sheath. The additional loops stabilize the tip and the filter can be pulled into the sheath. Conclusion The "multiple-loop-snare" technique is a refinement of the previously described "single loop-snare" technique and can be used when one loop fails.
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Affiliation(s)
- Arash Najafi
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Katerina Koulia
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Philippe Aubert
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Christoph A Binkert
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
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29
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Lee JTL, Goh GS, Joseph T, Koukounaras J, Phan T, Clements W. Prolonged balloon tamponade in the initial management of inferior vena cava injury following complicated filter retrieval, without the need for surgery. J Med Imaging Radiat Oncol 2018; 62:810-813. [DOI: 10.1111/1754-9485.12758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan TL Lee
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Gerard S Goh
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Jim Koukounaras
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Tuan Phan
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Warren Clements
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
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30
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Vena Cava Filter Retrieval with Aorto-Iliac Arterial Strut Penetration. Cardiovasc Intervent Radiol 2018; 41:1184-1188. [DOI: 10.1007/s00270-018-1963-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
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31
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Lee BE, Van Allan RJ, Friedman ML, Lipshutz HG. Complications and retrieval characteristics of Celect Platinum inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2018; 6:163-172. [DOI: 10.1016/j.jvsv.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
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32
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Desai KR, Laws JL, Salem R, Mouli SK, Errea MF, Karp JK, Yang Y, Ryu RK, Lewandowski RJ. Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary? An Analysis in 762 Procedures. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.003957. [PMID: 28606998 DOI: 10.1161/circinterventions.116.003957] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. METHODS AND RESULTS From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P<0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). CONCLUSIONS The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.
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Affiliation(s)
- Kush R Desai
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - James L Laws
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Riad Salem
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Samdeep K Mouli
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Martin F Errea
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Jennifer K Karp
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Yihe Yang
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Robert K Ryu
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.)
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (K.R.D., J.L.L., R.S., S.K.M., M.F.E., J.K.K., Y.Y., R.J.L.); and Department of Radiology, University of Colorado School of Medicine, Aurora (R.K.R.).
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Huang J, Bold M, Rajebi MR. Endovascular retrieval of Greenfield IVC filters 13 and 19 years post placement without major complication. J Radiol Case Rep 2018; 11:15-25. [PMID: 29299094 DOI: 10.3941/jrcr.v11i6.3031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Inferior vena cava (IVC) filters were first introduced in 1967 by Kazi Mobin-Uddin and later improved by Lazar Greenfield in the 1980s becoming a major component of catastrophic pulmonary embolism prevention. Nevertheless, filters are not entirely harmless. The long term risks include caval thrombosis, visceral penetration, and filters can serve as a nidus for infection. Filter retrieval is often complicated by intimal hyperplasia especially with increased indwelling time. Historically, Greenfield filters in place for longer than 3 weeks were considered permanent due to the risks of retrieval. Herein we present 2 cases of successful retrieval of Greenfield filters 13 and 19 years post implantation.
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Affiliation(s)
- Junjian Huang
- Department of Radiology, Pennsylvania Hospital, Philadelphia, USA
| | - Michael Bold
- Department of Radiology, Mayo Clinic, Rochester, USA
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Kansagra K, Vatakencherry GG, Do J, Keny AV, Rudikoff AG, Hernandez Conte A. Utilization of Transesophageal Echocardiography for Extraction of an Inferior Vena Cava Filter Fragment in the Right Ventricle. J Cardiothorac Vasc Anesth 2017; 32:2628-2632. [PMID: 29249577 DOI: 10.1053/j.jvca.2017.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Kartik Kansagra
- Department of Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | | | - John Do
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ameet V Keny
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Andrew G Rudikoff
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Antonio Hernandez Conte
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
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Desai KR, Pandhi MB, Seedial SM, Errea MF, Salem R, Ryu RK, Lewandowski RJ. Retrievable IVC Filters: Comprehensive Review of Device-related Complications and Advanced Retrieval Techniques. Radiographics 2017; 37:1236-1245. [PMID: 28696849 DOI: 10.1148/rg.2017160167] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of retrievable inferior vena cava filters (RIVCFs) has grown exponentially since their introduction into clinical practice, but many of these devices are not retrieved. Some are not retrieved due to poor clinical follow-up, but other devices remain in situ for extended periods because they present significant technical challenges during retrieval. Because of these and other factors, many of these devices were thus left in place permanently. However, recent data have placed a renewed emphasis on device retrieval due to increased risk of RIVCF-related complications, which are positively correlated with filter dwell time. Development of advanced filter retrieval techniques has had a significant impact on the removal of embedded RIVCFs, permitting retrieval of the majority of devices. The purpose of this article is to present an imaging and data review of the dominant device-related factors that complicate RIVCF retrieval and to describe the relevant advanced retrieval techniques to manage these factors. RIVCF imaging is frequently encountered in daily clinical practice via various imaging modalities. Therefore, diagnostic radiologists can play a vital role in identifying filter-related issues. Familiarity with the context for managing these issues in the interventional suite is essential for improving triage and care of patients with RIVCFs. © RSNA, 2017.
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Affiliation(s)
- Kush R Desai
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Mithil B Pandhi
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Stephen M Seedial
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Martin F Errea
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Riad Salem
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert K Ryu
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
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Litwin RJ, Huang SY, Sabir SH, Hoang QB, Ahrar K, Ahrar J, Tam AL, Mahvash A, Ensor JE, Kroll M, Gupta S. Impact of an inferior vena cava filter retrieval algorithm on filter retrieval rates in a cancer population. J Vasc Surg Venous Lymphat Disord 2017; 5:689-697. [DOI: 10.1016/j.jvsv.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Manzur M, Ochoa C, Ham SW, Lee W, Simcox T, Rowe V, Weaver F. Surgical Management of Perforated Inferior Vena Cava Filters. Ann Vasc Surg 2017; 42:25-31. [DOI: 10.1016/j.avsg.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/12/2016] [Accepted: 11/21/2016] [Indexed: 12/01/2022]
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Workman CS, Lewandowski RJ, Desai KR. Techniques for Retrieval of Permanent Inferior Vena Cava Filters. Semin Intervent Radiol 2017; 34:208-212. [PMID: 28607530 DOI: 10.1055/s-0037-1602597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cayce S Workman
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kush R Desai
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Du X, Li C, Qian A, Zhang Y, Li W, Yu H, Li X, Kong L. Bidirectional Pull-Back Technique for Retrieval of Strut-Embedded Cylinder-Shaped Filters in Inferior Vena Cava. Med Sci Monit 2017; 23:2796-2804. [PMID: 28596513 PMCID: PMC5473375 DOI: 10.12659/msm.904550] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND IVC filters have been widely accepted as an effective method to prevent pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). However, the placement of IVC filters is associated with significant complications and filter retrieval can be challenging when the filter struts are embedded into the caval wall. MATERIAL AND METHODS Over 26 months, we reviewed the safety and efficacy of the bidirectional pull-back technique for removing strut-embedded IVC filters in 15 consecutive patients. Retrieval procedural data such as in-dwell time, retrieval time, and fluoroscopy time were recorded. Clinical outcomes and procedure-related complications were evaluated by venography or enhanced computed tomography. Histologic tissue was analyzed to reveal the pathologic effects of chronic filter implantation. All patients underwent routine clinical follow-up at a mean time of 12 months (range, 8-14 months). RESULTS Technical success of filter retrieval was achieved in 100%, with mean implantation of 46.6 days (range, 27-66 days). Filter types were as follows: OptEase (n=11) and Aegisy (n=4). The mean retrieval time and fluoroscopy time were 21.43±5.42 min and 7.63±2.67 min, respectively. Immediate postprocedure venography showed no procedure-related complications. Thirteen patients discontinued previously prescribed lifelong anticoagulation. There were no long-term complications during follow-up. CONCLUSIONS The bidirectional pull-back technique is safe and efficient for filter retrieval. This complex technique can be particularly useful in selected patients to remove strut-embedded cylindrical-shaped IVC filters previously considered irretrievable.
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Affiliation(s)
- Xiaolong Du
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Chenglong Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Aimin Qian
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Yeqing Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Wendong Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Huiying Yu
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xiaoqiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Lingshang Kong
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
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Abstract
OPINION STATEMENT Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.
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Kuyumcu G, Walker TG. Inferior vena cava filter retrievals, standard and novel techniques. Cardiovasc Diagn Ther 2016; 6:642-650. [PMID: 28123984 DOI: 10.21037/cdt.2016.09.07] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The placement of an inferior vena cava (IVC) filter is a well-established management strategy for patients with venous thromboembolism (VTE) disease in whom anticoagulant therapy is either contraindicated or has failed. IVC filters may also be placed for VTE prophylaxis in certain circumstances. There has been a tremendous growth in placement of retrievable IVC filters in the past decade yet the majority of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include caval wall penetration, filter fracture or migration, caval thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). Difficulty is sometimes encountered when attempting to retrieve indwelling filters, mainly because of either abnormal filter positioning or endothelization of filter components that are in contact with the IVC wall, thereby causing the filter to become embedded. The length of time that a filter remains indwelling also impacts the retrieval rate, as increased dwell times are associated with more difficult retrievals. Several techniques for difficult retrievals have been described in the medical literature. These techniques range from modifications of standard retrieval techniques to much more complex interventions. Complications related to complex retrievals are more common than those associated with standard retrieval techniques. The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter, and should be individualized. This article summarizes current techniques for IVC filter retrieval from a clinical point of view, with an emphasis on advanced retrieval techniques.
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Affiliation(s)
- Gokhan Kuyumcu
- Cleveland Clinic Imaging Institute, Cleveland, OH 44195, USA
| | - T Gregory Walker
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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42
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Laws JL, Lewandowski RJ, Ryu RK, Desai KR. Retrieval of Inferior Vena Cava Filters: Technical Considerations. Semin Intervent Radiol 2016; 33:144-8. [PMID: 27247484 DOI: 10.1055/s-0036-1582119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Placement of retrievable inferior vena cava filters has seen rapid growth since their introduction into clinical practice. When retrieved, these devices offer the notional benefit of temporary protection from pulmonary embolism related to lower extremity deep venous thrombosis, and mitigation of filter-related deep venous thrombosis. When promptly removed after the indication for mechanical prophylaxis is no longer present, standard endovascular retrieval techniques are frequently successful. However, the majority of these devices are left in place for extended periods of time, which has been associated with greater device-related complications when left in situ, and failure of standard techniques when retrieval is attempted. The development of advanced retrieval techniques has had a positive impact on retrieval of these embedded devices. In this article, technical considerations in the retrieval of such devices, with an emphasis on advanced techniques to facilitate retrieval of embedded devices, are discussed.
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Affiliation(s)
- James L Laws
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Robert K Ryu
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Kush R Desai
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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43
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Etkin Y, Glaser JD, Nation DA, Foley PJ, Wang GJ, Woo EY, Fairman RM, Jackson BM. Retrievable inferior vena cava filters can always be removed using "fall-back" techniques. J Vasc Surg Venous Lymphat Disord 2016; 3:364-369. [PMID: 26992612 DOI: 10.1016/j.jvsv.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Retrievable inferior vena cava filters (IVCFs) left in place for a prolonged period can lead to complications including filter migration, fracture, and caval thrombosis. "Fall-back" techniques for IVCF retrieval that can be used when standard snaring is unsuccessful have been recently described. The purpose of this study was to analyze how incorporation of these new techniques affected the outcomes of IVCF retrievals at our institution during the past 5 years. METHODS Data were collected of all patients undergoing IVCF removal by vascular surgeons at a tertiary academic medical center between 2009 and 2013, including demographics and procedural and filter characteristics. A standard technique of snaring the retrieval hook was attempted first in all cases; if this was unsuccessful, a number of fall-back techniques were employed, including the use of endoscopic graspers, 18F sheaths, and snaring a second wire below the collar of the filter to collapse it into the sheath. RESULTS IVCF retrieval was attempted in 275 patients; 3 were excluded intraoperatively because of thrombus in the filter. Most filters (97%) were Günther Tulips (Cook Medical, Bloomington, Ind); 70% had been placed prophylactically before bariatric surgery. A total of 268 filters (98.5%) were retrieved successfully, 213 (79%) by standard snaring and 55 (21%) with fall-back techniques. In patients undergoing fall-back techniques, technical success was achieved 100% of the time. The median time since insertion was significantly longer in the fall-back group (173 days vs 83 days; P < .0001). Four intraoperative complications occurred; fractured wires embolized to the right atrium or pulmonary artery and were successfully removed endovascularly. The majority of the procedures (80%) were performed under sedation in both groups. CONCLUSIONS Incorporation of fall-back techniques may allow 100% technically successful and safe removal of retrievable IVCFs and is especially useful in removing filters with prolonged dwell time.
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Affiliation(s)
- Yana Etkin
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
| | - Julia D Glaser
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - David A Nation
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Paul J Foley
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Edward Y Woo
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, D.C
| | - Ronald M Fairman
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Benjamin M Jackson
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
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Yim NY, Kim JK, Kim HO, Kang YJ, Jung HD. Iliac Vein Stent Fracture Due to a Migrated Retrievable Vena Cava Filter. Vasc Endovascular Surg 2016; 50:94-7. [PMID: 26912396 DOI: 10.1177/1538574416628653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of iliac vein stent fracture due to hooking by a migrated retrievable inferior vena cava filter in a 55-year-old woman with acute deep venous thrombosis related to May-Thurner syndrome.
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Affiliation(s)
- Nam Yeol Yim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Yang Jun Kang
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Hye Doo Jung
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
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Abstract
Over the past decade, there has been a gradual evolution of the retrievable inferior vena cava (IVC) filter, as the indications for caval filtration have expanded since the first such filters came into use. However, the particular design of retrievable or optional filters has introduced a subset of both symptomatic and asymptomatic device failures that have prompted a reassessment in the approach to patient selection as well as a new lexicon of technical considerations when considering retrieval. The Denali Vena Cava Filter (Bard Peripheral Vascular, Inc., Tempe, AZ) represents one of the latest filters to come to market that specifically addresses the various issues of its predecessors. While the body of published experience with this filter is still relatively sparse, the incidence of filter tilt, strut perforation, strut fracture, and filter migration appears acceptably low and the filters remain relatively easy to retrieve even after long dwell times.
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Affiliation(s)
- David Hahn
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
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46
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Stavropoulos SW, Ge BH, Mondschein JI, Shlansky-Goldberg RD, Sudheendra D, Trerotola SO. Retrieval of Tip-embedded Inferior Vena Cava Filters by Using the Endobronchial Forceps Technique: Experience at a Single Institution. Radiology 2015; 275:900-7. [DOI: 10.1148/radiol.14141420] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee MJ, Valenti D, de Gregorio MA, Minocha J, Rimon U, Pellerin O. The CIRSE Retrievable IVC Filter Registry: Retrieval Success Rates in Practice. Cardiovasc Intervent Radiol 2015; 38:1502-7. [PMID: 25933644 DOI: 10.1007/s00270-015-1112-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/30/2015] [Indexed: 12/19/2022]
Abstract
CIRSE established a registry of retrievable filter use with the primary aim of determining the success of IVC Filter retrieval and associated complications. Secondary endpoints included filter indications, imaging strategies before retrieval, filter dwell times, and anticoagulation status. A web-based electronic registry was hosted between 01/12/2010 and 30/06/2012. Data entry occurred at the date of IVC filter retrieval and included items such as filter type, indication for filter insertion, access route, dwell time, retrieval success, complications, reasons for failed retrieval, and anticoagulation status. 671 filter retrievals were entered (male:female 333:295, mean age 55, median 57). Retrieval data were not entered in 43/671 leaving 628 patients for analysis. The 4 commonest retrievable filters used were the Celect in 182 patients, the OPTEASE in 161, ALN in 120, and Gunther Tulip in 98. Filters were inserted for absolute indications 40%, relative indications in 31%, and prophylactic in 24%, with 5% missing. Mean filter dwell time was 90 days. Filters were successfully retrieved in 576/628 patients (92%). The mean dwell time for successful retrievals was 85 days versus 145 days for unsuccessful retrievals (p = 0.001). Major complications occurred in 2 patients (0.03%). In summary, the CIRSE retrievable filter registry demonstrates a retrieval rate of 92% across a range of filter types, with a low major complication rate, reflecting current practice. There is an increase in trend of retrievable filter use for relative and prophylactic indications.
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Affiliation(s)
- M J Lee
- The Department of Academic Radiology, Beaumont Hospital, Dublin 9, Ireland.
| | - D Valenti
- Department of Radiology, McGill University, 354 Beaconsfield Blvd, Montreal, QC, H9W4A9, Canada.
| | - M A de Gregorio
- Department of Interventional Radiology, University of Zaragoza, Gomez Laguna, 13, 5° B, 50009, Saragossa, Spain.
| | - J Minocha
- Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, Suite 2483, Chicago, IL, 60612, USA.
| | - U Rimon
- Department of Diagnostic Radiology, Sheba Medical Center, 52621, Telhasomer, Israel.
| | - O Pellerin
- Department of Interventional Radiology, Université Paris 5 René Descartes, Hopital Européen Georges, Pompidou, 20 rue Leblanc, 75908, Paris, France.
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48
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Al-Hakim R, McWilliams JP, Derry W, Kee ST. The Hangman Technique: A Modified Loop Snare Technique for the Retrieval of Inferior Vena Cava Filters with Embedded Hooks. J Vasc Interv Radiol 2015; 26:107-10. [DOI: 10.1016/j.jvir.2014.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 10/24/2022] Open
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Cho E, Lim KJ, Jo JH, Jung GS, Park BH. Failed inferior vena cava filter retrieval by conventional method: Analysis of its causes and retrieval of it by modified double-loop technique. Phlebology 2014; 30:549-56. [PMID: 25096757 DOI: 10.1177/0268355514545353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the complications of the temporary implanted inferior vena cava (IVC) filter and the feasibility of double-loop technique for removal of complicated IVC filters. METHODS From January 2012 to December 2013, a total of 25 patients with IVC filter were referred for IVC filter retrieval. There were 20 Celect®, 3 OptEase®, and 2 Günther-Tulip® filters. All of the patients were evaluated with a pre-procedural CT scan to identify any complications. The IVC filters which had failed to be retrieved by the conventional method were evaluated, and retrieval was attempted with double loop technique. RESULTS Sixteen of 25 (64%) filters had complications; IVC wall penetration (n = 11, 44%), tilted within IVC (n = 6, 24%), embedded struts (n = 3, 12%), and fracture of the strut (n = 1, 4%). The complications were overlapped in five patients. Two of them (8%) had also complained of filter-related pain. The success rate of IVC filter retrieval by double-loop technique was 14/16 (87.5%). There was no major filter retrieval-related complications. CONCLUSIONS The double-loop technique is a safe and feasible method for complicated IVC filter retrieval.
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Affiliation(s)
- Eun Cho
- Department of Radiology, Dong-A University Hospital, South Korea
| | - Kyung Jae Lim
- Department of Radiology, Dong-A University Hospital, South Korea
| | - Jeong Hyun Jo
- Department of Radiology, Dong-A University Hospital, South Korea
| | - Gyoo-Sik Jung
- Department of Radiology, Kosin University Gospel Hospital, South Korea
| | - Byeong Ho Park
- Department of Radiology, Dong-A University Hospital, South Korea
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Avgerinos E, Bath J, Stevens J, McDaniel B, Marone L, Dillavou E, Cho J, Makaroun M, Chaer R. Technical and Patient-related Characteristics Associated with Challenging Retrieval of Inferior Vena Cava Filters. Eur J Vasc Endovasc Surg 2013; 46:353-9. [DOI: 10.1016/j.ejvs.2013.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
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