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Xuan T, Jianlong L, Jinyong L, Xiao L, Mi Z, Ruifeng B, Zhong C. Antegrade and retrograde approaches with a mechanical thrombectomy device for the treatment of acute lower limb deep vein thrombosis. Ann Vasc Surg 2024:S0890-5096(24)00282-6. [PMID: 38942376 DOI: 10.1016/j.avsg.2024.04.014] [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: 12/16/2023] [Revised: 03/07/2024] [Accepted: 04/06/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To examine the efficacy of antegrade and retrograde approaches with the AngioJet thrombectomy device for the treatment of acute lower limb deep vein thrombosis (DVT) and to evaluate the necessity of filter placement. METHODS The clinical data of patients with acute lower limb DVT treated with the AngioJet device from January 2021 to June 2023 were retrospectively analyzed. The patients were divided into the antegrade and retrograde treatment groups according to the surgical approach and the direction of valve opening. The thrombosis interception rate of the filter, incidence of pulmonary embolism (PE), thrombectomy effectiveness, venous obstruction rate, and thrombosis recurrence rate of each treatment group were evaluated. In addition, factors affecting patency were analyzed. RESULTS AngioJet was employed for 84 patients with acute lower limb DVT, treating a total of 88 limbs. The thrombosis interception rate of the filter was 35.7% (30 patients). The incidence of new PE or PE exacerbation was 6.0% (5 patients), and a filter retrieval rate of 97.6% (82 patients) was detected. Thrombus removal of grade III occurred in 35 (64.8%) of the 54 limbs (61.4%) in the antegrade treatment group, versus 13 (38.2%) of the 34 limbs (38.6%) in the retrograde treatment group (P<0.05). At 3 months, venous patency and bleeding events involved 52 (96.3%) and 4 (7.4%) limbs in the antegrade treatment group, respectively, versus 29 (85.3%) and 2 (5.9%) in the retrograde treatment group, respectively (P>0.05). Regression analysis was performed to determine factors that may affect 3-month patency in both groups. Statistically significant linear relationships were found between 3-month patency and thrombus removal rate [OR=0.546 (0.326, 0.916)], thrombus formation time [OR=1.018 (1.002, 1.036)], and preoperative thrombosis score [OR=1.012 (1.002, 1.022)] in the antegrade treatment group, as well as thrombus removal rate [0.473 (0.229, 0.977)] in the retrograde treatment group. In regression analysis of factors affecting patency in both groups and VCSS/Villalta score, a statistically significant linear relationship was found between thrombus formation time and VCSS score in the antegrade treatment group [0.576 (0.467, 0.710)]. CONCLUSION Both antegrade and retrograde approaches are safe and effective for the treatment of acute lower limb DVT. There are no differences in 3-month deep vein patency and post-thrombotic syndrome (PTS) incidence rates. Individuals with acute lower limb DVT are at high risk of thrombus shedding after treatment with AngioJet thrombectomy, and placement of a vena cava filter (VCF) is recommended for effective interception.
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Affiliation(s)
- Tian Xuan
- Vascular Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029; Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Liu Jianlong
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Li Jinyong
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Liu Xiao
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Zhou Mi
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Bai Ruifeng
- Department of Clinical Laboratory; Department of Laboratory Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100029
| | - Chen Zhong
- Vascular Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029.
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Visconti L, Celi A, Carrozzi L, Tinelli C, Crocetti L, Daviddi F, De Caterina R, Madonna R, Pancani R. Inferior vena cava filters: Concept review and summary of current guidelines. Vascul Pharmacol 2024; 155:107375. [PMID: 38663572 DOI: 10.1016/j.vph.2024.107375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Anticoagulation is the first-line approach in the prevention and treatment of pulmonary embolism. In some instances, however, anticoagulation fails, or cannot be administered due to a high risk of bleeding. Inferior vena cava filters are metal alloy devices that mechanically trap emboli from the deep leg veins halting their transit to the pulmonary circulation, thus providing a mechanical alternative to anticoagulation in such conditions. The Greenfield filter was developed in 1973 and was later perfected to a model that could be inserted percutaneously. Since then, this model has been the reference standard. The current class I indication for this device includes absolute contraindication to anticoagulants in the presence of acute thromboembolism and recurrent thromboembolism despite adequate therapy. Additional indications have been more recently proposed, due to the development of removable filters and of progressively less invasive techniques. Although the use of inferior vena cava filters has solid theoretical advantages, clinical efficacy and adverse event profile are still unclear. This review analyzes the most important studies related to such devices, open issues, and current guideline recommendations.
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Affiliation(s)
- Luca Visconti
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Ospedale "Sacro Cuore di Gesù" Gallipoli, Azienda Sanitaria Locale Lecce, Italy
| | - Alessandro Celi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Camilla Tinelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Crocetti
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Interventional Radiology Unit, University of Pisa, Pisa, Italy
| | - Francesco Daviddi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Interventional Radiology Unit, University of Pisa, Pisa, Italy
| | - Raffaele De Caterina
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Cardiology Unit, Cardio-Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rosalinda Madonna
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Cardiology Unit, Cardio-Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roberta Pancani
- Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Lei K, DiCaro MV, Tak N, Turnbull S, Abdallah A, Cyrus T, Tak T. Contemporary Management of Pulmonary Embolism: Review of the Inferior Vena Cava filter and Other Endovascular Devices. Int J Angiol 2024; 33:112-122. [PMID: 38846989 PMCID: PMC11152642 DOI: 10.1055/s-0044-1785231] [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: 06/09/2024] Open
Abstract
Inferior vena cava (IVC) filters and endovascular devices are used to mitigate the risk of pulmonary embolism in patients presenting with lower extremity venous thromboembolism in whom long-term anticoagulation is not a good option. However, the efficacy and benefit of these devices remain uncertain, and controversies exist. This review focuses on the current use of IVC filters and other endovascular therapies in clinical practice. The indications, risks, and benefits are discussed based on current data. Further research and randomized controlled trials are needed to characterize the patient population that would benefit most from these interventional therapies.
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Affiliation(s)
- KaChon Lei
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Michael V. DiCaro
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Nadia Tak
- Research Associate, University of Minnesota - Twin Cities, Minneapolis, Minnesota
| | - Scott Turnbull
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Ala Abdallah
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Tillman Cyrus
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, North Las Vegas, Nevada
| | - Tahir Tak
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, North Las Vegas, Nevada
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4
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Houghton DE, Carman T. Caution: Inferior vena cava filters in distal deep vein thrombosis. Vasc Med 2024:1358863X241255968. [PMID: 38818712 DOI: 10.1177/1358863x241255968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Damon E Houghton
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Teresa Carman
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA
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Haddad P, Peng J, Drake M, Rahimi M. Inferior Vena Cava Filters: An Overview. Methodist Debakey Cardiovasc J 2024; 20:49-56. [PMID: 38765211 PMCID: PMC11100533 DOI: 10.14797/mdcvj.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 05/21/2024] Open
Abstract
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
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Affiliation(s)
- Paul Haddad
- Houston Methodist Hospital, Houston, Texas, US
| | | | | | - Maham Rahimi
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Fontyn S, Bai Y, Bolger S, Greco K, Wang TF, Hamm C, Cervi A. Inferior vena cava filter use at a large community hospital: a retrospective cohort study. Sci Rep 2024; 14:10192. [PMID: 38702341 PMCID: PMC11068867 DOI: 10.1038/s41598-024-60868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Inferior vena cava (IVC) filters are considered when patients with venous thromboembolism (VTE) develop a contraindication to anticoagulation. Use of IVC filters is increasing, despite associated complications and lack of data on efficacy in reducing VTE-related mortality. We characterized the pattern of IVC filter use at a large community hospital between 2018 and 2022. Specifically, we assessed the indications for IVC filter insertion, filter removal rates, and filter-associated complications. Indications for IVC filters were compared to those outlined by current clinical practice guidelines. We reviewed 120 consecutive filter placement events. The most common indications included recent VTE and active bleeding (40.0%) or need for anticoagulation interruption for surgery (25.8%). Approximately one-third (30.0%) of IVC filters were inserted for indications either not supported or addressed by guidelines. Half (50.0%) of patients had successful removal of their IVC filter. At least 13 patients (10.8%) experienced a filter-related complication. In a large community-based practice, nearly one-third of IVC filters were inserted for indications not universally supported by current practice guidelines. Moreover, most IVC filters were not removed, raising the risk of filter-associated complications, and supporting the need for development of comprehensive guidelines addressing use of IVC filters, and post-insertion monitoring practices.
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Affiliation(s)
| | - Yuxin Bai
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Samantha Bolger
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Kaity Greco
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Caroline Hamm
- Schulich School of Medicine and Dentistry, London, ON, Canada
- Department of Medical Oncology, Windsor Regional Cancer Centre, 1995 Lens Avenue, Windsor, ON, N8W 1L9, Canada
| | - Andrea Cervi
- Schulich School of Medicine and Dentistry, London, ON, Canada.
- Department of Medical Oncology, Windsor Regional Cancer Centre, 1995 Lens Avenue, Windsor, ON, N8W 1L9, Canada.
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Chatzelas DA, Pitoulias AG, Bontinis V, Zampaka TN, Tsamourlidis GV, Bontinis A, Potouridis AG, Tachtsi MD, Pitoulias GA. Can Routine Investigation for Occult Pulmonary Embolism Be Justified in Patients with Deep Vein Thrombosis? Vasc Specialist Int 2024; 40:12. [PMID: 38661144 PMCID: PMC11046297 DOI: 10.5758/vsi.240017] [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: 02/01/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose This study aims to investigate whether routine screening for silent pulmonary embolism (PE) can be justified in patients with deep vein thrombosis (DVT). Materials and Methods We retrospectively analyzed the medical records of 201 patients with lower-extremity DVT admitted to the vascular surgery department of a single tertiary university center between 2019 and 2023. All patients underwent clinical evaluation, basic laboratory exams, a whole-leg colored duplex ultrasound, and a computed tomography pulmonary angiography (CTPA), to screen for an occult, underlying PE. Results The overall incidence of silent PE was 48.8%. The median admission D-dimer level was significantly higher in patients with silent PE than in those without PE (9.60 vs. 5.51 mg/L, P=0.001). A D-dimer value ≥5.14 mg/L was discriminant for predicting silent PE, with a sensitivity of 68.2% and a specificity of 59.3%. Silent PE was significantly more common on the right side, with the embolus located at the main pulmonary, lobar, segmental, and subsegmental arteries in 29.6%, 32.7%, 20.4%, and 17.3%, respectively. A higher incidence of occult PE was observed in patients with iliofemoral DVT (P=0.037), particularly when the thrombus extended to the inferior vena cava (P=0.003). Moreover, iliofemoral DVT was associated with a larger size and a more proximal location of the embolus (P=0.041). Multivariate logistic regression showed that male sex (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.39-3.53; P=0.026), cancer (OR=2.76, 95% CI: 1.45-4.07; P=0.017), previous venous thromboembolism (VTE) history (OR=2.67, 95% CI: 1.33-4.01; P=0.022), D-dimer value ≥5.14 mg/L (OR=2.24, 95% CI: 1.10-3.38; P=0.033), iliofemoral DVT (OR=2.13, 95% CI: 1.19-3.07; P=0.041), and thrombus extension to the IVC (OR=2.95, 95% CI: 1.43-4.47; P=0.009) served as independent predictors for silent PE. Conclusion A high incidence of silent PE was observed in patients with lower-extremity DVT. Screening of patients with DVT who have the aforementioned predictive risk factors using CTPA for silent PE may be needed and justified for the efficient management of VTE and its long-term complications.
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Affiliation(s)
- Dimitrios A. Chatzelas
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Apostolos G. Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, Faculty of Medicine, “AHEPA” University Hospital of Thessaloniki, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodosia N. Zampaka
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Georgios V. Tsamourlidis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Faculty of Medicine, “AHEPA” University Hospital of Thessaloniki, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios G. Potouridis
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Maria D. Tachtsi
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
| | - Georgios A. Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General Hospital of Thessaloniki, Greece
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Aronow HD, Bonaca MP, Kolluri R, Beckman JA. Recapturing the Team Approach to Vascular Care. Ann Vasc Surg 2024; 101:84-89. [PMID: 38128694 DOI: 10.1016/j.avsg.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The care of the vascular patient remains decentralized rather than coordinated. METHODS We reviewed the current state of practice and published competency and care documents created by vascular professional societies. RESULTS Vascular professional societies routinely and repeatedly endorse both a team approach and the competency of specialists from disparate training backgrounds. The care of the vascular patient does not always reflect these public endorsements. CONCLUSIONS Centering the vascular patient as the mode of organization of care should improve care processes, expertise brought to bear, and outcomes.
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Affiliation(s)
- Herbert D Aronow
- Henry Ford Health, Detroit, MI; Michigan State University College of Human Medicine, East Lansing, MI
| | - Marc P Bonaca
- CPC Clinical Research, Aurora, CO; University of Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | - Raghu Kolluri
- OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus, OH
| | - Joshua A Beckman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Huynh K, Sanchala A, Ekiz A. Recurrent Deep Vein Thrombosis (DVT) and Inferior Vena Cava (IVC) Filter: Should a Computed Tomography (CT) Venogram and Inferior Vena Cavagram Be the Standard of Care? Cureus 2024; 16:e58529. [PMID: 38957832 PMCID: PMC11218494 DOI: 10.7759/cureus.58529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 07/04/2024] Open
Abstract
A pulmonary embolism (PE) is a life-threatening complication of deep vein thrombosis (DVT). Although timely anticoagulation is the first-line treatment for DVT, an inferior vena cava (IVC) filter can be considered when anticoagulation is contraindicated. Unfortunately, IVC filters come with complications of their own, including thrombus formation in or around the filter. An 89-year-old man with a past medical history of coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and prior DVT status post IVC filter implantation five years ago in 2018 presented with hypotension, dizziness, and syncope. Computed tomography angiography (CTA) of the chest showed bilateral PEs. Venous Doppler ultrasound of the bilateral lower extremities was negative for DVT. CT venogram was performed; however, the contrast filling was suboptimal and as such, a venous thrombosis could not be ruled out. Therefore, an inferior vena cavagram was performed through the right common femoral vein and confirmed a large thrombus positioned cephalad to the IVC filter. A thrombectomy was performed and the IVC filter was replaced given the patient was at high risk for venous thromboembolism recurrence and complications. Although an IVC filter offers some protection from recurrent PEs, it does have risks and complications. As seen in our patient, the IVC filter can be a nidus for the formation of a thrombus which has the risk of dislodging. When evaluating a patient for the source of a PE, it is important to consider prior IVC implant and perform further workups, such as a CT venogram or an inferior vena cavagram, to evaluate for thrombus in or around the filter.
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Affiliation(s)
- Kathleen Huynh
- Internal Medicine, Touro College of Osteopathic Medicine, Middletown, USA
| | - Anju Sanchala
- Physical Medicine and Rehabilitation, Garnet Health Medical Center, Middletown, USA
| | - Ayfer Ekiz
- Internal Medicine, Garnet Health Medical Center, Middletown, USA
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López N, Zamora-Martinez C, Montoya-Rodes M, Gabara C, Ortiz M, Aibar J. Comparison of inferior vena cava filter use and outcomes between cancer and non-cancer patients in a tertiary hospital. Thromb Res 2024; 236:136-143. [PMID: 38447420 DOI: 10.1016/j.thromres.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND While accepted indications for the use of inferior vena cava filter (IVCF) in patients with a venous thromboembolism (VTE) have remained stable, their use continues to be frequent. Retrieval rates are still low, being particularly notable in the population with cancer. This study aims to review the rate of adherence to guidelines recommendation and to compare retrieval rates and complications in both cancer and non-cancer patients. METHODS A retrospective study was performed including 185 patients in whom an IVCF was placed in Hospital Clinic of Barcelona. Baseline characteristics, clinical outcomes, and IVCF-related outcomes were analyzed. A strongly recommended indication (SRI) was considered if it was included in all the revised clinical guidelines and non-strongly if it was included in only some. RESULTS Overall, 47 % of the patients had a SRI, without differences between groups. IVCF placement after 29 days from the VTE event was more frequent in the cancer group (46.1 vs. 17.7 %). Patients with cancer (48.1 % of the cohort) were older, with higher co-morbidity and bleeding risk. Anticoagulation resumption (75.3 % vs. 92.7 %) and IVCF retrieval (50.6 % vs. 66.7 %) were significantly less frequent in cancer patients. No significant differences were found regarding IVCF-related complications, hemorrhagic events and VTE recurrence. CONCLUSIONS SRI of IVCF placement was found in less than half of the patients. Cancer patients had higher rates of IVCF placement without indication and lower anticoagulation resumption and IVCF retrieval ratios, despite complications were similar in both groups.
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Affiliation(s)
- Néstor López
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martinez
- Medical Oncology Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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11
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Moorthy GC, Craig JL, Ferrara E, Quinn RJ, Stavropoulos SW, Trerotola SO. Supply Costs in Complex and Routine Inferior Vena Cava Filter Retrieval: 10 Years' Data from a Single Center. J Vasc Interv Radiol 2024; 35:583-591.e1. [PMID: 38160750 DOI: 10.1016/j.jvir.2023.12.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To characterize the medical supply costs associated with inferior vena cava filter retrieval (IVCFR) using endobronchial forceps (EFs), a snare, or Recovery Cone (RC). MATERIALS AND METHODS In total, 594 of 845 IVCFRs attempted at a tertiary referral hospital between October 1, 2012, and June 20, 2022 were categorized by intended retrieval strategy informed by, rotational cavography as follows: (a) EF (n = 312) for tilted or tip-embedded/strut-embedded filters and for long-dwelling closed-cell filters and (b) a snare (n = 255) or (c) RC (n = 27) for other well-positioned filters with or mostly without hooks, respectively. List prices of relevant supplies at time of retrieval were obtained or, rarely, estimated using a standard procedure. Contrast use, fluoroscopic time, filter type, dwell time, and patient age and sex were recorded. Mean between-group cost differences were estimated by linear regression, adjusting for date. Additional models evaluated filter type, dwell time, and patient-level effects. RESULTS Of the 594 IVCFRs, 591 were successful, whereas 2 EF and 1 snare retrievals failed. Moreover, 4 EF retrievals were successful with a snare and 2 with smaller EF, 12 snare retrievals were successful with EF, 1 RC retrieval was successful with a snare and 2 with EF. Principal model indicated a significantly lower mean cost of EF ($564.70, SE ± 9.75) than that of snare ($811.29, SE ± 10.83; P < .0001) and RC ($1,465.48, SE ± 47.12; P < .0001) retrievals. Adjusted models yielded consistent results. Had all retrievals been attempted with EF, estimated undiscounted full-period supplies savings would be $87,201.51. CONCLUSIONS EFs are affordable for complex IVCFR, and extending their use to routine IVCFR could lead to considerable cost savings.
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Affiliation(s)
- Gyan C Moorthy
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. https://twitter.com/HistoryonRecord
| | - Jason L Craig
- Endovascular Division, Abbott Laboratories, Santa Clara, California
| | - Edward Ferrara
- Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Ryan J Quinn
- Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Jahangiri Y, Morrison JJ, Mowery ML, Leach AJ, Musolf RL, Knox MF. Effectiveness and Safety of Large-Bore Aspiration Thrombectomy for Intermediate- or High-Risk Pulmonary Embolism. J Vasc Interv Radiol 2024; 35:563-575. [PMID: 38160751 DOI: 10.1016/j.jvir.2023.12.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/10/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To evaluate effectiveness and safety of large-bore mechanical thrombectomy of intermediate- or high-risk pulmonary embolism (PE) and factors associated with effectiveness. MATERIALS AND METHODS A retrospective review of 257 patients with intermediate- or high-risk PE who underwent mechanical thrombectomy using the Flowtriever system (Inari Medical, Irvine, California) between July 2019 and November 2021 was conducted. Data were analyzed using the linear regression and Kaplan-Meier methods with a Type 1 error set at 0.05. RESULTS Patients' mean age was 62 years, and 51% were male. PE risk was classified as high, intermediate-high, and intermediate-low in 37 (14%), 201 (78%), and 18 (7%) of the patients, respectively. Procedural technical success was 100%. The mean pulmonary artery pressure (MPAP) decreased from a mean of 32 mmHg (SD ± 9) before to 24 mmHg (SD ± 9) after thrombectomy (mean decrease, 8 mmHg [SD ± 6]; P < .0001). Immediate complications occurred in 2% of the patients. Postprocedural 30-day and all-time PE-attributable mortality in a mean of 1.3-year follow-up was 2% and 6%, respectively. In multivariate analysis, the presence of lower extremity DVT at presentation (β ± SE, -7.60 ± 3.22; P = .019) and a higher prethrombectomy MPAP (β ± SE, -0.19 ± 0.04; P < .001) were associated with lower degrees of decrease in MPAP in the intermediate-high-risk PE group. Among 14 patients with postthrombectomy PE-attributable mortality, 13 had postthrombectomy MPAPs of >20 mmHg. CONCLUSIONS Large-bore aspiration thrombectomy is a safe and effective treatment for reducing PAP in patients with intermediate- or high-risk PE. Postthrombectomy MPAPs of >20 mmHg might indicate postthrombectomy PE-attributable mortality in high-risk patients.
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Affiliation(s)
- Younes Jahangiri
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan.
| | - James J Morrison
- Advanced Radiology Services, Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Myles L Mowery
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Aaron J Leach
- Corewell Health Interventional Radiology, Michigan State University, Grand Rapids, Michigan
| | - Ryan L Musolf
- Corewell Health Diagnostic Radiology, Michigan State University, Grand Rapids, Michigan
| | - Michael F Knox
- Advanced Radiology Services, Interventional Radiology, Michigan State University, Grand Rapids, Michigan
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Liu Y, Ma J, Wang Q, Zeng W, He C. Successful retrieval of tip-embedded inferior vena cava filter using a modified forceps technique: case report. Thromb J 2024; 22:25. [PMID: 38475817 DOI: 10.1186/s12959-024-00595-7] [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: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The retrieval of inferior vena cava (IVC) filter is essential for preventing complications associated with the device. Advanced techniques have been developed to improve the success rate of retrieving tip-embedded filters. The forceps technique is frequently used to address this issue. CASE PRESENTATION We present a case study of two patients who underwent a successful tip-embedded IVC filter retrieval using a modified forceps technique, which has not been previously reported. This technique involves using a wire loop under the filter tip and a forceps to grasp the filter shoulder. By pulling the wire loop and pushing the forceps in counterforce, the filter tip is straightened and aligned with the vascular sheath. The vascular sheath can then dissect the filter tip out from the caval wall and get inside the sheath to complete the retrieval. CONCLUSIONS The modified forceps technique we present here offers a new solution for the complex retrieval of IVC filters.
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Affiliation(s)
- Yang Liu
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Junlong Ma
- Department of Hepato-biliary-pancreatic and Vascular surgery, Meishan municipal people's hospital, Meishan, Sichuan, CN, China
| | - Qiqi Wang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Wei Zeng
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China.
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Asmar S, Michael G, Gallo V, Weinberg MD. The Role of IVC Filters in the Management of Acute Pulmonary Embolism. J Clin Med 2024; 13:1494. [PMID: 38592401 PMCID: PMC10935447 DOI: 10.3390/jcm13051494] [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: 01/18/2024] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent cardiovascular condition, ranking third globally after myocardial infarction and stroke. The risk of VTE rises with age, posing a growing concern in aging populations. Acute PE, with its high morbidity and mortality, emphasizes the need for early diagnosis and intervention. This review explores prognostic factors for acute PE, categorizing it into low-risk, intermediate-risk, and high-risk based on hemodynamic stability and right ventricular strain. Timely classification is crucial for triage and treatment decisions. In the contemporary landscape, low-risk PE patients are often treated with Direct Oral Anticoagulants (DOACS) and rapidly discharged for outpatient follow-up. Intermediate- and high-risk patients may require advanced therapies, such as systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy, and IVC filter placement. The latter, particularly IVC filters, has witnessed increased usage, with evolving types like retrievable and convertible filters. However, concerns arise regarding complications and the need for timely retrieval. This review delves into the role of IVC filters in acute PE management, addressing their indications, types, complications, and retrieval considerations. The ongoing debate surrounding IVC filter use, especially in patients with less conventional indications, reflects the need for further research and data. Despite complications, recent studies suggest that clinically significant issues are rare, sparking discussions on the appropriate and safe utilization of IVC filters in select PE cases. The review concludes by highlighting current trends, gaps in knowledge, and potential avenues for advancing the role of IVC filters in future acute PE management.
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Affiliation(s)
- Samer Asmar
- Division of Cardiology, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA;
| | - George Michael
- Division of Vascular & Interventional Radiology, Department of Radiology, Staten Island University Hospital—Northwell Health, Staten Island, NY 10305, USA; (G.M.); (V.G.)
| | - Vincent Gallo
- Division of Vascular & Interventional Radiology, Department of Radiology, Staten Island University Hospital—Northwell Health, Staten Island, NY 10305, USA; (G.M.); (V.G.)
| | - Mitchell D. Weinberg
- Division of Cardiology, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA;
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El Dick J, Shah P, Paul AK. Utilization Practices of Inferior Vena Cava Filters at an Academic Medical Center. Cureus 2024; 16:e55505. [PMID: 38571863 PMCID: PMC10990477 DOI: 10.7759/cureus.55505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Anticoagulation is the mainstay of management for patients with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Inferior vena cava (IVC) filters are indicated in select patients who are not candidates for anticoagulation. There is a lack of quality evidence supporting other indications. In addition, long-term benefits and safety profiles of IVC filters have not been established. We investigated the utilization practice of IVC filters in a contemporary series of patients in a tertiary academic medical center. METHODOLOGY A retrospective review of 200 patients who received IVC filters at Virginia Commonwealth University (VCU) Medical Center in the years 2017 and 2018 was conducted. Adult patients 18 years of age or older with or without cancer were included, and patients were selected consecutively until data on 200 patients were collected. Data on patient demographics, an indication of IVC filter placement, filter retrieval rate, and re-thrombosis events over a median follow-up period of nine months were extracted from the electronic medical record and analyzed. RESULTS A total of 200 patients (105 male and 95 female) were included with a median age of 61 years (range 17-92 years). Of the 200 patients, 97 (48.5%) had a DVT, 28 (14%) had a PE, 73 (36.5%) had both a PE and DVT, and 2 (1%) had thrombosis at other sites. A total of 130 (65%) patients had an IVC filter placed because of a contraindication to anticoagulation, while 70 (35%) had an IVC filter placed for other nonstandard indications, which included new or worsening VTE despite anticoagulation, recent VTE who must have anticoagulation held during surgery, primary prevention in high-risk patients, and extensive disease burden among other reasons. Seventy-two (36%) patients had active malignancy at the time of filter placement, and 64 (32%) were lost to follow-up. Of the 119 patients who were potentially eligible for filter retrieval, 55 (46%) patients had their IVC filters removed at a median of five months after insertion. Of the 55 patients who had IVC filters removed, 8 (14.5%) patients experienced a re-thrombosis event within a median follow-up of 39 months. Of the 145 patients who still had their filter in place at the time of death or last follow-up, 5 (3.4%) patients experienced a re-thrombosis event within a median follow-up of three months. CONCLUSIONS One-third of the patients in this series had an IVC filter placed without a standard indication, and less than half of them had the IVC filters removed within one year of placement. Additionally, one-third of the patients were lost to follow-up, highlighting the need for improved structured follow-up programs and education among both patients and providers regarding the indications for placement and retrieval to minimize complications.
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Affiliation(s)
- Joud El Dick
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, USA
| | - Palak Shah
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Medical Center, Richmond, USA
| | - Asit Kr Paul
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Medical Center, Richmond, USA
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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kang T, Lu YL, Han S, Li XQ. Comparative outcomes of catheter-directed thrombolysis versus AngioJet pharmacomechanical catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12:101669. [PMID: 37625507 DOI: 10.1016/j.jvsv.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE The objective of this study was to compare the outcomes of pharmacomechanical thrombolysis and thrombectomy (PCDT) plus catheter-directed thrombolysis (CDT) vs CDT alone for the treatment of acute iliofemoral deep vein thrombosis (DVT) and summarize the clinical experience, safety outcomes, and short- and long-term efficacy. METHODS We performed a 4-year retrospective, case-control study. A total of 95 consecutive patients with acute symptomatic iliofemoral deep vein thrombosis (DVT) with a symptom duration of ≤7 days involving the iliac and/or common femoral veins underwent endovascular interventions. The patients were divided into two groups according to their clinical indications: PCDT plus CDT vs CDT alone. Statistical analyses were used to compare the clinical characteristics and outcomes between the two groups. Additionally, the patients were followed up for 3 to 36 months after treatment, and the proportions of post-thrombotic syndrome (PTS) and moderate to severe PTS were analyzed using the Kaplan-Meier survival method. RESULTS A total of 95 consecutive patients were analyzed in this retrospective study, of whom, 51 underwent CDT alone and 44 underwent PCDT plus CDT. Between the two groups, in terms of immediate-term efficacy and safety, significant differences were found in the catheter retention time (60.64 ± 12.04 hours vs 19.42 ± 4.04 hours; P < .001), dosages of urokinase required (5.82 ± 0.81 million units vs 1.80 ± 0.64 million units; P < .001), the detumescence rate at 24 hours postoperatively (48.46% ± 8.62% vs 76.79% ± 7.98%; P = .026), the descent velocity of D-dimer per day (2266.28 ± 1358.26 μg/L/D vs 3842.34 ± 2048.02 μg/L/D; P = .018), total hospitalization stay (6.2 ± 1.40 days vs 3.8 ± 0.70 days; P = .024), number of postoperative angiograms (2.4 ± 0.80 vs 1.2 ± 0.30; P = .042), and grade III venous patency (>95% lysis: 54.5% vs 68.6%; P = .047). Furthermore, during the follow-up period, significant differences were found in the incidence of PTS (Villalta scale ≥5 or a venous ulcer: 47.0% vs 27.7%; P = .037), and the incidence proportion of moderate to severe PTS at 12 months (15.7% vs 4.5%; P = .024) and 24 months (35.3% vs 11.4%; P = .016). CONCLUSIONS Compared with CDT alone, in the iliofemoral DVT subgroup with a symptom duration of ≤7 days, PCDT plus CDT could significantly relieve early leg symptoms, shorten the hospitalization stay, reduce bleeding complications, promote long-term venous patency, and decrease the occurrence of PTS and the incidence proportion of moderate to severe PTS. Thus, the short- and long-term outcomes both support the superiority of PCDT plus CDT vs CDT in this subgroup.
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Affiliation(s)
- Tao Kang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Vascular Surgery, The First People's Hospital of Taicang, Taicang, China
| | - Yao-Liang Lu
- Department of Vascular Surgery, The First People's Hospital of Taicang, Taicang, China
| | - Song Han
- Department of Vascular Surgery, The First People's Hospital of Taicang, Taicang, China
| | - Xiao-Qiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Migliaro GO, Noya JA, Tupayachi Villagómez OD, Donato BN, Allin JG, Leiva GG, Álvarez JA. Predictors of retrieval and long-term mortality in patients treated with inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2024; 12:101648. [PMID: 37453550 DOI: 10.1016/j.jvsv.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Inferior vena cava filters (VCFs) are a therapeutic resource for the treatment of patients with thromboembolic disease who have a contraindication to full-dose anticoagulation. In the present study, we report the retrieval rate and long-term mortality of patients receiving optional inferior VCFs and identify the predictors for retrieval and all-cause mortality during follow-up. METHODS We conducted a retrospective cohort study of 739 consecutive recipients of optional inferior VCFs from January 2002 to December 2021 in two hospitals. Different clinical characteristics and procedure-related variables were included in the analysis. The all-cause mortality rate and retrieval rate and the predictive factors were evaluated using multivariate analysis. RESULTS Of the 739 patients, 393 (53%) were women. The mean patient age was 69 ± 15 years. Of the patients, 67% presented with pulmonary thromboembolism and 43% with deep vein thrombosis (DVT). A contraindication to anticoagulation was present for nearly 90% of the patients, mainly (47%) related to the surgical procedure. In addition, 44% of the patients had active cancer. Follow-up data were available for 94% of the patients, with an average follow-up time of 6.08 ± 5.83 years. Long-term mortality was 53%. Cancer (odds ratio [OR], 3.60; 95% confidence interval [CI], 2.22-5.83), age (OR, 1.03; 95% CI, 1.08-1.42), and DVT (OR, 2.01; 95% CI, 1.08-1.42) were identified as independent predictors of mortality. The retrieval rate at follow-up was 33%. The predictors for retrieval included the indication of the filter related to a surgical procedure (OR, 4.85; 95% CI, 2.54-9.59), the absence of cancer (OR, 2.89; 95% CI, 1.45-5.75), and younger age (OR, 0.98; 95% CI, 0.97-0.99). CONCLUSIONS High long-term mortality was observed. The predictors of mortality were cancer, older age, and DVT. One third of the filters implanted were retrieved. The predictors for retrieval were a contraindication to surgery-related anticoagulation, the absence of cancer, and younger age.
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Affiliation(s)
- Guillermo O Migliaro
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina; Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - Juan A Noya
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina; Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Omar D Tupayachi Villagómez
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina; Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Brian N Donato
- Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Jorge G Allin
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina
| | - Gustavo G Leiva
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina; Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - José A Álvarez
- Division of Interventional Cardiology, Hospital Alemán, Buenos Aires, Argentina; Division of Interventional Cardiology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Schastlivtsev I, Pankov A, Tsaplin S, Stepanov E, Zhuravlev S, Lobastov K. Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study. Clin Appl Thromb Hemost 2024; 30:10760296241256938. [PMID: 38778542 PMCID: PMC11113020 DOI: 10.1177/10760296241256938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava (IVC) filter implantation. METHOD This retrospective analysis includes data from 100 patients with deep vein thrombosis (DVT) who underwent IVC filter implantation due to a free-floating thrombus (n = 64), thrombus propagation (n = 8), or acute bleeding (n = 8) on therapeutic anticoagulation, catheter-directed thrombolysis (n = 8), or had previously implanted filter with DVT recurrence. Patients were treated with warfarin (n = 41) or rivaroxaban (n = 59) for 3-12 months. Symptomatic venous thromboembolism (VTE) recurrence and bleeding events were assessed at 12 months follow-up. RESULTS Three (7.3%) cases of VTE recurrence without IVC filter occlusion occurred on warfarin and none on rivaroxaban. The only (2.4%) major bleeding occurred on warfarin. Three (5.1%) clinically relevant non-major bleedings were detected on rivaroxaban. No significant differences existed between groups when full and propensity scores matched datasets were compared. CONCLUSIONS Rivaroxaban seems not less effective and safe than warfarin after IVC filter implantation.
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Affiliation(s)
- Ilya Schastlivtsev
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Aleksey Pankov
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Sergey Tsaplin
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Evgeny Stepanov
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sergey Zhuravlev
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Kirill Lobastov
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
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20
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Ryce AL, Lee SJ, Ahmed O, Majdalany BS, Kokabi N. Contemporary Use of Prophylactic Inferior Vena Cava Filters in Patients With Severe Traumatic Injuries and High Thromboembolic Event Risk. J Am Coll Radiol 2023:S1546-1440(23)01039-6. [PMID: 38157951 DOI: 10.1016/j.jacr.2023.12.020] [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: 10/14/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between prophylactic inferior vena cava filter (IVCF) implantation and in-hospital deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality among adults with intracranial, pelvic or lower extremity, and spinal cord injuries. METHODS Patients 18 years and older with severe intracranial, pelvic or lower extremity, or spinal cord injuries captured by the Trauma Quality Improvement Program (2010-2019) were identified. IVCFs implanted ≤72 hours after hospital presentation and before performance of lower extremity ultrasonography were defined as prophylactic. Patients were stratified by pharmacologic venous thromboembolism (VTE) prophylaxis status. Logistic regression models estimated prophylactic inferior vena cava (IVC) filtration's effect on selected outcomes and identified attributes associated with prophylactic IVCF implantation. RESULTS Of 544,739 included patients, 1.3% (n = 7,247) underwent prophylactic IVCF implantation. Among patients who received pharmacologic VTE prophylaxis, prophylactic IVC filtration compared with expectant management was positively associated with DVT (odds ratio [OR], 4.30; P < .001) and PE (OR, 4.30; P < .001) but not associated with mortality (OR, 0.92; P = .43). Among patients who received no pharmacologic prophylaxis, prophylactic IVC filtration was positively associated with DVT (OR, 4.63; P < .001) and PE (OR, 5.02; P < .001) but negatively associated with mortality (OR, 0.43; P < .001). CONCLUSIONS Prophylactic IVC filtration was associated with increased likelihood of VTE among all adults with severe intracranial, pelvic or lower extremity, and spinal cord injuries. In patients who received no pharmacologic VTE prophylaxis, prophylactic IVC filtration was associated with decreased likelihood of in-hospital mortality.
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Affiliation(s)
- Arrix L Ryce
- Wellstar Kennestone Regional Medical Center, Marietta, Georgia. https://twitter.com/A_Ryce
| | - Scott J Lee
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan. https://twitter.com/scottlee_md
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois. https://twitter.com/TheRealDoctorOs
| | - Bill S Majdalany
- Division of Interventional Radiology, Department of Radiology, University of Vermont, Burlington, Vermont. https://twitter.com/billmajdalany
| | - Nima Kokabi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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21
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Yang J, He QF, Fan BR, Jin YH. Inferior vena cava filter misplacement caused by the special anatomy of inferior vena cava: A case report. Asian J Surg 2023; 46:5874-5876. [PMID: 37679201 DOI: 10.1016/j.asjsur.2023.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Jian Yang
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Qi-Fan He
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Bao-Rui Fan
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yong-Hai Jin
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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22
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Kang RD, Schuchardt P, Charles J, Kumar P, Drews E, Kazi S, DePalma A, Fang A, Raymond A, Davis C, Massis K, Hoots G, Mhaskar R, Nezami N, Shaikh J. Predictors of endobronchial forceps utilization for inferior vena cava filter retrieval: when snare retrieval fails. CVIR Endovasc 2023; 6:55. [PMID: 37950835 PMCID: PMC10640549 DOI: 10.1186/s42155-023-00392-9] [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: 06/03/2023] [Accepted: 08/15/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps. METHODS Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail. RESULTS Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05). CONCLUSION IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps. LEVEL OF EVIDENCE Level 3, large multicenter retrospective cohort.
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Affiliation(s)
- Richard D Kang
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Philip Schuchardt
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
| | - Jonathan Charles
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Premsai Kumar
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
| | - Elena Drews
- Department of Radiology and Image Guided Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Stephanie Kazi
- Department of Radiology and Image Guided Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Andres DePalma
- Department of Radiology and Image Guided Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aislynn Raymond
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cliff Davis
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
- Radiology Associates of Florida, Tampa, FL, USA
| | - Kamal Massis
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
- Radiology Associates of Florida, Tampa, FL, USA
| | - Glenn Hoots
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
- Radiology Associates of Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jamil Shaikh
- Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA.
- Radiology Associates of Florida, Tampa, FL, USA.
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23
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Rahmani G, O'Sullivan GJ. Acute and chronic venous occlusion. Br J Radiol 2023; 96:20230242. [PMID: 37750946 PMCID: PMC10607425 DOI: 10.1259/bjr.20230242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/04/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
This review article provides an overview of acute and chronic venous occlusion, a condition that can cause significant morbidity and mortality if not diagnosed and treated promptly. The article begins with an introduction to the anatomy of the venous system, followed by a discussion of the causes and clinical features of venous occlusion. The diagnostic tools available for the assessment of venous occlusion, including imaging modalities such as ultrasound, CT, and MRI, are then discussed, along with their respective advantages and limitations. The article also covers the treatment options for acute and chronic venous occlusion, including anticoagulant therapy and endovascular interventions. This review aims to provide radiologists with an updated understanding of the pathophysiology, diagnosis, and management of acute and chronic venous occlusion.
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Affiliation(s)
- George Rahmani
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
| | - Gerard J O'Sullivan
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
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24
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Grubman S, Kostiuk V, Brahmandam A, Tonnessen B, Mojibian H, Schneider E, Guzman RJ, Chaar CIO. Effect of inferior vena cava filter placement position on device complications. J Vasc Surg Venous Lymphat Disord 2023; 11:1165-1174.e2. [PMID: 37356713 DOI: 10.1016/j.jvsv.2023.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/03/2023] [Accepted: 05/27/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Indwelling inferior vena cava (IVC) filters can cause complications, including penetration into surrounding structures, migration, and thrombosis of the vena cava. Computational fluid dynamics suggests juxtarenal placement of IVC filters decreases the risk of thrombosis; however, this has not been explored clinically. The present study examines the effect of filter placement position on long-term device complications with an emphasis on IVC thrombosis. We hypothesized that IVC filters placed further caudal to the renal veins were more likely to develop long-term thrombosis. METHODS A retrospective review of the medical records of patients receiving IVC filters at a single tertiary center between 2008 and 2016 was performed. Patients missing follow-up or procedural imaging data were excluded. The placement procedure venograms were reviewed, and the distance from the filter apex to the more inferior renal vein was measured using reported IVC filter lengths for calibration. The patients were divided into three groups according to the tip position relative to the more inferior renal vein: at or superior (group A), 1 to 20 mm inferior (group B), and >20 mm inferior (group C). The patient and procedural characteristics and outcomes were compared between the three groups. The primary end points were IVC thrombosis and device-related mortality. RESULTS Of 1497 eligible patients, 267 (17.8%) were excluded. The most common placement position was group B (64.0%). The mean age was lowest in group C, followed by groups A and B (age, 59.5 years, 64.6 years, and 62.2 years, respectively; P = .003). No statistically significant differences were found in the distribution of sex or the measured comorbidities. Group C was the most likely to receive jugular access (group C, 71.7%; group A, 48.3%; group B, 62.4%; P < .001) and received more first-generation filters (group C, 58.5%; group A, 46.6%; group B, 52.5%; P = .045). The short-term (<30-day) and long-term (≥30-day) outcomes, including access site hematoma, deep vein thrombosis, and pulmonary embolism, were uncommon, with no differences between the groups. Cases of symptomatic filter penetration, migration, and fracture were rare (one, one, and three cases, respectively). Although a pattern of increasing thrombosis with more inferior placement was found, the difference between groups was not statistically significant (group A, 1.5%; group B, 1.8%; group C, 2.5%; P = .638). No cases of device-related mortality occurred. All-cause mortality after a mean follow-up of 2.6 ± 2.3 years was 41.3% and did not vary significantly between the groups (P = .051). Multivariate logistic regression revealed that placement position did not predict for short- or long-term deep vein thrombosis, pulmonary embolism, IVC thrombosis, or all-cause mortality after adjustment for the baseline patient characteristics. CONCLUSIONS IVC filters have low rates of short- and long-term complications, including IVC thrombosis. The placement position did not affect the occurrence of device complications in this study.
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Affiliation(s)
- Scott Grubman
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Valentyna Kostiuk
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Anand Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Britt Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Hamid Mojibian
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Eric Schneider
- Center for Health Services and Outcomes Research, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
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25
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Kesselman A, Kuo WT. Beyond the AJR: The Excimer Laser-Assisted Retrieval of Embedded IVC Filters. AJR Am J Roentgenol 2023; 221:700. [PMID: 36946896 DOI: 10.2214/ajr.23.29323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- Andrew Kesselman
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H3630, Stanford, CA 94305-5642
| | - William T Kuo
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H3630, Stanford, CA 94305-5642
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26
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Choe J, Liang R, Weinberg AS, Tapson VF. Guideline Compliance and Indications for Inferior Vena Cava Filter Placement at a Quaternary Care Medical Center. J Endovasc Ther 2023:15266028231204822. [PMID: 37882162 DOI: 10.1177/15266028231204822] [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: 10/27/2023]
Abstract
PURPOSE This study investigated physician compliance with indications for inferior vena cava (IVC) filter placement according to the 2012 American College of Chest Physicians (ACCP) and the 2011 Society of Interventional Radiology (SIR) guidelines. MATERIALS AND METHODS A retrospective medical record review of 231 retrievable IVC filters placed between August 15, 2016, and December 28, 2017, at a large urban academic medical center. Guideline compliance to the 2012 ACCP and the 2011 SIR guidelines, and indications for IVC filter placements were assessed through an adjudication protocol. Filter retrieval and complication rates were also examined. RESULTS Compliance to guidelines was low (60.2% for ACCP; 74.0% for SIR), especially for non-intensive care unit (ICU) patients (ICU 74.6% vs non-ICU 54.8%, p=0.007 for ACCP; ICU 82.5% vs non-ICU 70.8%, p=0.092 for SIR). After adjudication, 8.2% (19/231) of filters were considered non-indicated but reasonable, 17.7% (41/231) non-indicated and unreasonable, and 13.9% (32/231) SIR-indicated but not ACCP-indicated. The most common indication was venous thromboembolism with contraindication to anticoagulation. The most common reasons for non-compliance were distal deep venous thrombosis with contraindication to anticoagulation (19/60, 31.6%) and clot burden (19/60, 31.6%). One-year filter retrieval and 90-day complication rates were 32.0% (74/231) and 6.1% (14/231), respectively. CONCLUSION Compliance to established guidelines was low. Reasons for non-compliance included limitations or discrepancies in guidelines, as well as non-evidence-based filter placements. CLINICAL IMPACT Despite increasing utilization of inferior vena cava (IVC) filters, guideline compliance for IVC filter placement among providers is unclear. The results of this study indicate that physician compliance to established guidelines is poor, especially in non-intensive-care-unit patients. Noncompliance stems from non-evidence-based filter placement as well as differences and limitations in guidelines. Avoiding non-indicated IVC filter placement and consolidation of guidelines may significantly improve guideline compliance. The critical insights gained from this study can help promote judicious use of IVC filters and highlight the role of venous thromboembolism experts in navigating complex cases and nuances of guidelines.
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Affiliation(s)
- June Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Liang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Aaron S Weinberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Victor F Tapson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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27
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Gong M, Jiang R, Zhao B, Kong J, Liu Z, Qian C, He X, Gu J. Relationship between vascular access and angulation of vena cava filter at placement and retrieval: a multicenter retrospective cohort study. Ther Adv Chronic Dis 2023; 14:20406223231200254. [PMID: 37745816 PMCID: PMC10515605 DOI: 10.1177/20406223231200254] [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: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Inferior vena cava (IVC) filters are commonly used intravascular devices designed to prevent fatal pulmonary embolism (PE), maintaining the IVC filter as centered as possible is fundamental for achieving its filtration function. Objective This study aimed to characterize the tilt angles of IVC filter between the vascular access of internal jugular vein (IJV) and femoral vein (FV), as well as to identify factors associated with increased or decreased tilt angles between placement and retrieval. Design This is a multicenter retrospective study. Methods A multicenter retrospective study was conducted from October 2017 to March 2019. The primary outcome was the change in filter tilt between placement and retrieval. The secondary outcome was the identifications of factors associated with increased or decreased tilt angle. Relevant variables were analyzed using t-tests, Chi-square tests, Fisher's exact tests, while multivariate logistic regression analysis was used to determine risk factors. Results A total of 184 eligible patients were included in this study. The IJV group had a lower likelihood of tilt angle over 10° at the time of placement compared to the FVs group (0% versus 12.5%, p = 0.040). Among the 171 patients with a mean dwell time of 22.1 days, the IJV group had a higher likelihood of tilt angle over 10° than the FVs group (10.3% versus 2.3%, p = 0.080). The use of FVs access at placement was associated with a higher difference between placement and retrieval filter tilt angles (p < 0.01). Multivariate logistic regression analysis showed that hypertension [odds ratio (OR) 0.668; 95% confidence interval (CI) 0.328-1.358, p = 0.265], cardiologic artery disease (OR 0.537; 95% CI 0.136-2.130, p = 0.377), cerebral venous disease (OR 0.555; 95% CI 0.186-1.651, p = 0.290), filter types (OR 1.624; 95% CI 0.851-3.096, p = 0.141), and IVC filter thrombosis (OR 1.634; 95% CI 0.804-3.323, p = 0.175) were not associated with increased filter tilt angle. Right side (OR 0.434; 95% CI 0.202-0.930, p = 0.032) or bilateral lower extremity deep vein thrombosis (LEDVT) (OR 0.383; 95% CI 0.148-0.995, p = 0.049) were identified as protective factors. Conclusion IJV access was associated with a lower filter tilt angle at the time of placement, while FVs access was linked to a higher difference between placement and retrieval tilt angles. Right side or bilateral LEDVT were identified as protective factors against increased IVC filter tilt angle.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Rui Jiang
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Boxiang Zhao
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Jie Kong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Zhengli Liu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Cheng Qian
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P. R. China
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28
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Osztrogonacz PJ, Munawar L, Auyang P, Chinnadurai P, Lumsden AB. Endovascular retrieval of a fractured Optease inferior vena cava filter using endobronchial forceps and intraoperative cone-beam computed tomography guidance. J Vasc Surg Cases Innov Tech 2023; 9:101187. [PMID: 37799830 PMCID: PMC10547734 DOI: 10.1016/j.jvscit.2023.101187] [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: 12/19/2022] [Accepted: 03/28/2023] [Indexed: 10/07/2023] Open
Abstract
Endovascular retrieval of fractured inferior vena cava (IVC) filters after the manufacturer recommended indwelling time can be challenging and require advanced retrieval techniques. We describe an endovascular retrieval technique of a fractured Optease IVC filter in a 57-year-old woman using endobronchial forceps and intraoperative cone-beam computed tomography guidance. Following incomplete filter retrieval, the location and orientation of fractured strut was confirmed by cone-beam computed tomography venography. The embedded filter fragment was then successfully removed using endobronchial forceps via a transjugular venous approach. In the present report, we highlight the additional value of intraoperative cross-sectional imaging, in conjunction with advanced endovascular techniques, for retrieval of challenging IVC filters.
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Affiliation(s)
- Peter J. Osztrogonacz
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Leena Munawar
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Philip Auyang
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
- Siemens Medical Solutions USA Inc, Malvern, PA
| | - Alan B. Lumsden
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
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29
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Swietlik JF, Rose AE, Meram E, Schwartz BS, Matsumura JS, Laeseke PF. Reengaging patients with forgotten filters through an institutional multidisciplinary approach. J Vasc Surg Venous Lymphat Disord 2023; 11:995-1003. [PMID: 37120039 DOI: 10.1016/j.jvsv.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the outcomes of a hospital-wide multidisciplinary initiative to reengage and manage patients with unretrieved chronic indwelling inferior vena cava (IVC) filters placed at a large tertiary care center, who had been lost to follow-up. METHODS We performed a retrospective review of outcomes from a completed multidisciplinary quality improvement project. The quality improvement project identified and contacted (via letter) patients with chronic indwelling IVC filters placed at a single tertiary care center from 2008 to 2016 who were alive and without evidence of filter retrieval in the medical records. A total of 316 eligible patients were mailed a letter regarding their chronic indwelling IVC filter and the updated recommendations regarding IVC filter removal. The letter included institutional contact information, and all the patients who responded were offered a clinic visit to discuss potential filter retrieval. In the retrospective review, we assessed the outcomes of the quality improvement project, including the patient response rate, follow-up clinic visits, new imaging studies generated, retrieval rate, procedural success, and complications. The patient demographics and filter characteristics were collected and evaluated for correlations with the response and retrieval rates. RESULTS The patient response rate to the letter was 32% (101 of 316). Of the 101 patients who responded, 72 (71%) were seen in clinic and 59 (82%) underwent new imaging studies. Using standard and advanced techniques, 34 of 36 filters after a median dwell time of 9.4 years (range, 3.3-13.3 years) were successfully retrieved (94% success rate). The patients with a documented IVC filter complication were more likely to respond to the letter (odds ratio, 4.34) and undergo IVC filter retrieval (odds ratio, 6.04). No moderate or severe procedural complications occurred during filter retrieval. CONCLUSIONS An institutional, multidisciplinary quality initiative successfully identified and reengaged patients with chronic indwelling IVC filters who had been lost to follow-up. The filter retrieval success rate was high and procedural morbidity low. Institution-wide efforts to identify and retrieve chronic indwelling filters are feasible.
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Affiliation(s)
- John F Swietlik
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Anne E Rose
- Department of Pharmacy, UW Health, Madison, WI
| | - Ece Meram
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bradford S Schwartz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Morgridge Institute for Research, University of Wisconsin, Madison, WI
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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30
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Akpan IJ, Hunt BJ. How I approach the prevention and treatment of thrombotic complications in hospitalized patients. Blood 2023; 142:769-776. [PMID: 37339577 DOI: 10.1182/blood.2021014835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023] Open
Abstract
This article uses case-based discussion to review prevention and management of thrombotic problems in hospitalized patients that involve a clinical hematologist. There is variation in the clinical hematologist's role in thrombosis practice throughout the world, and we discuss this where indicated. Hospital-associated venous thromboembolism (VTE), or hospital-associated thrombosis (HAT), is the term to cover VTE occurring during admission and for 90 days postdischarge and is a common patient safety problem. HATs are the most common cause of VTE accounting for 55% to 60% of all VTE, with an estimated 10 million occurring globally. VTE risk assessment alongside evidence-based thromboprophylaxis reduces this risk significantly. Many hospitalized patients, especially older patients, use direct oral anticoagulants (DOACs), mainly to prevent stroke in atrial fibrillation. DOACs require perioperative management and may need urgent reversal. Other complex interventions such as extracorporeal membrane oxygenation which require anticoagulation are also discussed. Lastly, those with uncommon high-risk thrombophilias, especially those with antithrombin deficiency, produce unique challenges when hospitalized.
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Affiliation(s)
- Imo J Akpan
- Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, NY
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Lee S, Cho Y, Lee HN, Park SJ, Chung HH, Park H. Single-Session Percutaneous Mechanical Thrombectomy for Acute and Subacute Deep Vein Thrombosis: Clinical Outcomes and Predictive Factors of Recurrence. J Belg Soc Radiol 2023; 107:60. [PMID: 37600563 PMCID: PMC10437142 DOI: 10.5334/jbsr.3213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To evaluate the efficacy and safety of single-session percutaneous mechanical thrombectomy (PMT) for deep vein thrombosis (DVT), to compare clinical outcomes and recurrences between acute and subacute DVT, and to identify factors predicting recurrence. Materials and Methods From January 2018 to March 2021, 100 consecutive patients (age: 64.64 ± 17.28 years; male, 42%) with symptomatic DVT who underwent single-session PMT were enrolled for this study. These patients were divided into an acute DVT group (< 14 days, n = 75) and a subacute DVT group (15-28 days, n = 25). Results A large-bore aspiration thrombectomy was used in 80 (80%) cases, Angiojet (Boston Scientific, Marlborough, MA, USA) device in one (1%) case, and a combination of both techniques in 19 (19%) cases. The anatomic success rate was 97% and the clinical success rate was 95%. There were no major complications. Clinical outcomes were not different between the two groups. The recurrence-free survival rate in the acute DVT group was significantly (p = 0.015) better than that in the subacute DVT group. The anatomic success (HR, 52.3; 95% CI, 3.82-715.21; p = 0.003) and symptom duration (HR, 17.58; 95% CI, 1.89-163.34; p = 0.012) were predictive factors associated with recurrence. Conclusions Single-session PMT is safe and effective for immediate symptom relief in acute and subacute DVT patients. However, recurrence occurred more frequently in patients with subacute DVT than in those with acute DVT. Anatomic success of the procedure and duration of symptoms were independent predictors of DVT recurrence.
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Affiliation(s)
- Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju-si, Republic of Korea
| | - Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Hyerim Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
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Jo J, Diaz M, Horbinski C, Mackman N, Bagley S, Broekman M, Rak J, Perry J, Pabinger I, Key NS, Schiff D. Epidemiology, biology, and management of venous thromboembolism in gliomas: An interdisciplinary review. Neuro Oncol 2023; 25:1381-1394. [PMID: 37100086 PMCID: PMC10398809 DOI: 10.1093/neuonc/noad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Patients with diffuse glioma are at high risk of developing venous thromboembolism (VTE) over the course of the disease, with up to 30% incidence in patients with glioblastoma (GBM) and a lower but nonnegligible risk in lower-grade gliomas. Recent and ongoing efforts to identify clinical and laboratory biomarkers of patients at increased risk offer promise, but to date, there is no proven role for prophylaxis outside of the perioperative period. Emerging data suggest a higher risk of VTE in patients with isocitrate dehydrogenase (IDH) wild-type glioma and the potential mechanistic role of IDH mutation in the suppression of production of the procoagulants tissue factor and podoplanin. According to published guidelines, therapeutic anticoagulation with low molecular weight heparin (LMWH) or alternatively, direct oral anticoagulants (DOACs) in patients without increased risk of gastrointestinal or genitourinary bleeding is recommended for VTE treatment. Due to the elevated risk of intracranial hemorrhage (ICH) in GBM, anticoagulation treatment remains challenging and at times fraught. There are conflicting data on the risk of ICH with LMWH in patients with glioma; small retrospective studies suggest DOACs may convey lower ICH risk than LMWH. Investigational anticoagulants that prevent thrombosis without impairing hemostasis, such as factor XI inhibitors, may carry a better therapeutic index and are expected to enter clinical trials for cancer-associated thrombosis.
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Affiliation(s)
- Jasmin Jo
- Department of Internal Medicine, Division of Hematology and Oncology, East Carolina University, Greenville, NC, USA
| | - Maria Diaz
- Department of Neurology, Division of Neuro-Oncology, Columbia University, New York, NY, USA
| | - Craig Horbinski
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - Nigel Mackman
- Department of Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen Bagley
- Department of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Marika Broekman
- Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Janusz Rak
- Department of Pediatrics, McGill University, Montreal, Canada
| | - James Perry
- Department of Neurology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Ingrid Pabinger
- Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Nigel S Key
- Department of Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - David Schiff
- Department of Neurology, Division of Neuro-Oncology, University of Virginia, Charlottesville, VA, USA
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Cochran RL, Ghoshhajra BB, Hedgire SS. Body and Extremity MR Venography: Technique, Clinical Applications, and Advances. Magn Reson Imaging Clin N Am 2023; 31:413-431. [PMID: 37414469 DOI: 10.1016/j.mric.2023.04.004] [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: 07/08/2023]
Abstract
Magnetic resonance venography (MRV) represents a distinct imaging approach that may be used to evaluate a wide spectrum of venous pathology. Despite duplex ultrasound and computed tomography venography representing the dominant imaging modalities in investigating suspected venous disease, MRV is increasingly used due to its lack of ionizing radiation, unique ability to be performed without administration of intravenous contrast, and recent technical improvements resulting in improved sensitivity, image quality, and faster acquisition times. In this review, the authors discuss commonly used body and extremity MRV techniques, different clinical applications, and future directions.
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Affiliation(s)
- Rory L Cochran
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Bissacco D, Mandigers TJ, Romagnoli S, Aprea T, Lomazzi C, D'Alessio I, Ascenti V, Ierardi AM, Domanin M, Tolva VS, Carrafiello G, Trimarchi S. Acute venous problems: Integrating medical, surgical, and interventional treatments. Semin Vasc Surg 2023; 36:307-318. [PMID: 37330243 DOI: 10.1053/j.semvascsurg.2023.04.013] [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: 02/11/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy.
| | - Tim J Mandigers
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Aprea
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Vascular Surgery Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianpaolo Carrafiello
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
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Jingquan L, Fan Z, Ziqiang S, Jifu L, Zongbin L, Xianghong Y, Renhua S, Jun H. Echocardiographic Image of Extracorporeal Membrane Oxygenation Cannula-Associated Inferior Vena Cava Thrombosis and Filter Implantation. Chest 2023; 163:e275-e279. [PMID: 37295886 DOI: 10.1016/j.chest.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 06/12/2023] Open
Affiliation(s)
- Liu Jingquan
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
| | - Zhang Fan
- Emergency and Critical Care Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shao Ziqiang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Lai Jifu
- General Surgery, Cancer Center, Department of Vascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Lin Zongbin
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yang Xianghong
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Sun Renhua
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Hong Jun
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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36
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Williams B, Keefe NA. Utilization of Intravascular Ultrasound in the Management of Venous Disease. Tech Vasc Interv Radiol 2023; 26:100898. [PMID: 37865445 DOI: 10.1016/j.tvir.2023.100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
As the field of Vascular and Interventional Radiology continues to grow, the variety of pathology treated, the approaches to treating various disease processes, and the vast options of equipment and devices continue to grow as well. Numerous venous disease processes have now become commonplace within the treatment realm of interventional radiologists and knowing how to approach each disease process is critical to successful management of these complex patients. A few of the most encountered venous disease processes include pelvic venous disorders, vena cava tumor involvement, venous thrombosis, and inferior vena cava filter placement; an understanding of the management of these processes is integral to the practice of today's interventional radiologists. Intravascular ultrasound (IVUS) has become increasingly important both in the diagnosis and in guiding treatment for venous disease. This article will describe in detail the multiple ways that IVUS can be used in the treatment of complex venous disorders.
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Affiliation(s)
- Baxter Williams
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nicole A Keefe
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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37
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Dawson DL. PRESERVE trial confirms low risk for most inferior vena cava filters, but benefit remains uncertain. J Vasc Surg Venous Lymphat Disord 2023; 11:586. [PMID: 37080687 DOI: 10.1016/j.jvsv.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 04/22/2023]
Affiliation(s)
- David L Dawson
- Division of Vascular Surgery, Baylor Scott and White Medical Center, Temple, TX
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38
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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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39
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Lukies M, Moriarty H, Clements W. Which caval diameter? Clarification manufacturer's instructions for inferior vena cava filter use and implications for practice. Clin Radiol 2023; 78:310-314. [PMID: 36746721 DOI: 10.1016/j.crad.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/24/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
AIM To clarify manufacturer's instructions for inferior vena cava (IVC) filter use and implications for practice. MATERIALS AND METHODS Three vendors of IVC filters were contacted for clarification, with all stating that caval diameter limits are to be true maximum and true minimum cross-sectional diameters. To determine the implications of this, measurements were performed on 302 abdominal computed tomography studies in four transaxial dimensions perpendicular to the long axis including true maximum and minimum diameters, and measurements reflecting those typically taken on fluoroscopic cavography. RESULTS Based on the true maximum and true minimum caval diameter limits as clarified by vendors, 22% of patients who would typically be considered suitable for IVC filter insertion based on frontal and lateral fluoroscopic cavography would be contraindicated, and 40% of patients who would typically be considered suitable for IVC filter insertion based on only frontal fluoroscopic cavography (as lateral projection is often not performed) would be contraindicated. CONCLUSION There is a marked discordance between the vendor-clarified caval diameter limits of three common IVC filter devices and real-world caval geometry. Given the rarity of complications, this suggests a pressing need for revision of manufacturers' instructions for use statements to better reflect current safe routine clinical use, particularly from a medicolegal perspective.
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Affiliation(s)
- M Lukies
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia; Department of Diagnostic and Interventional Imaging, KK Women Women's and Children's Hospital, Singapore, Singapore.
| | - H Moriarty
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - W Clements
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia; National Trauma Research Institute, Melbourne, VIC, Australia
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40
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Berry J, Patell R, Zwicker JI. The bridging conundrum: perioperative management of direct oral anticoagulants for venous thromboembolism. J Thromb Haemost 2023; 21:780-786. [PMID: 36709100 PMCID: PMC11000626 DOI: 10.1016/j.jtha.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
Most patients diagnosed with venous thromboembolism (VTE) are currently treated with direct oral anticoagulants (DOACs). Before an invasive procedure or surgery, clinicians face the challenging decision of how to best manage DOACs. Should the DOAC be held, for how long, and are there instances where bridging with other anticoagulants should be considered? Although clinical trials indicate that most patients taking DOACs for atrial fibrillation do not require bridging anticoagulation, the optimal strategy for patients with a history of VTE is undefined. In this review, we present a case-based discussion for DOAC interruption perioperatively in patients receiving anticoagulation for management of VTE.
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Affiliation(s)
- Jonathan Berry
- Division of Hematology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/jlberrymd
| | - Rushad Patell
- Division of Hematology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/rushadpatell
| | - Jeffrey I Zwicker
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
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41
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Alshaqaq HM, Al-Sharydah AM, Alshahrani MS, Alqahtani SM, Amer M. Prophylactic Inferior Vena Cava Filters for Venous Thromboembolism in Adults With Trauma: An Updated Systematic Review and Meta-Analysis. J Intensive Care Med 2023; 38:491-510. [PMID: 36939472 DOI: 10.1177/08850666231163141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.
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Affiliation(s)
- Hassan M Alshaqaq
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopedics surgery, 48102King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Amer
- Medical/Critical Pharmacy Division, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, 101686Alfaisal University, Riyadh, Saudi Arabia
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Garg T, Altun I, Majdalany BS, Nezami N. Collapse of inferior vena cava during complex filter retrieval with consequent intra-procedural systemic hypotension and bradycardia: a case report. CVIR Endovasc 2023; 6:15. [PMID: 36928471 PMCID: PMC10020385 DOI: 10.1186/s42155-023-00361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Prolonged dwelling time of inferior vena cava (IVC) filters has been shown to increase the need for the use of complex IVC filter retrieval techniques. In this report, we describe a case of complex retrieval of an IVC filter with prolonged dwelling time, which was temporarily accompanied by severe bradycardia and hypotension. CASE PRESENTATION Fifty-nine-year-old male patient past medical history of morbid obesity, atrial fibrillation status post-ablation, obstructive sleep apnea, and end-stage renal disease presented for IVC filter retrieval 16 years after placement. When the IVC filter was covered by sheaths, and the IVC was temporarily collapsed and occluded, the patient developed severe bradycardia and hypotension without compensatory tachycardia. Contrast injection through the common femoral vein sheath showed complete occlusion of IVC while the IVC filter was covered by both sheaths, likely due to the embedment of the IVC filter in the wall by extensive fibrinous tissues. IVC filter was successfully retrieved, and the blood pressure and heart rate were improved immediately afterward. A large non-occlusive IVC thrombus was identified on the final venogram, which was aspirated using a mechanical thrombectomy device. CONCLUSION Complex retrieval of IVC filters with prolonged dwelled time can result in acute severe bradycardia and hypotension due to vasovagal reaction, acute collapse, and occlusion of IVC in the setting of IVC filter embedment in the wall by extensive fibrinous tissues.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Izzet Altun
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bill S Majdalany
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Olanipekun T, Ritchie C, Abe T, Effoe V, Chris-Olaiya A, Biney I, Erben YM, Guru P, Sanghavi D. Updated Trends in Inferior Vena Cava Filter Use by Indication in the United States After Food and Drug Administration Safety Warnings: A Decade Analysis From 2010 to 2019. J Endovasc Ther 2023:15266028231156089. [PMID: 36859812 DOI: 10.1177/15266028231156089] [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: 03/03/2023]
Abstract
BACKGROUND Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status. METHODS Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) "treatment" in patients with VTE diagnosis and contraindication to anticoagulation and "prophylaxis" in patients without VTE. Generalized linear regression was used to analyze utilization trends. RESULTS A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of -8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (-11.6% vs -7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of -7.9% and -10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (-17.2%) and prophylactic indications (-18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (-10.3%) and prophylactic indications (-12.5%). CONCLUSION The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions. CLINICAL IMPACT Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 - 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.
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Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN, USA
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Charles Ritchie
- Department of Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Valery Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Interventional Cardiology, Aurora Health Care, Milwaukee, WI, USA
| | - Abimbola Chris-Olaiya
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Isaac Biney
- Department of Pulmonary and Critical Care Medicine, The University of Tennessee Medical Center, Knoxville, TN, USA
| | - Young M Erben
- Department of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pramod Guru
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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Albertson N, Rice M, Schmitz A, Eskew J, Haste P, Johnson MS. Clinical and imaging outcomes of OptionELITE vena cava filter placement procedures. J Vasc Surg Venous Lymphat Disord 2023; 11:310-317. [PMID: 36179788 DOI: 10.1016/j.jvsv.2022.08.005] [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: 01/25/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We sought to determine the clinical and imaging outcomes after placement of the OptionELITE inferior vena cava (IVC) filter (Argon Medical Devices, Plano, TX). METHODS The clinical characteristics and imaging findings of patients who had undergone OptionELITE filter placement at six affiliated hospitals between January 1, 2013 and April 19, 2019, were analyzed. Data were obtained from the Radiology Information System, imaging database, and electronic medical records. The patients were followed up until 1 month after filter removal, death, or the first clinic visit and imaging study after June 1, 2019. RESULTS A total of 603 filter placement procedures in 594 patients were evaluated. Of the 603 procedures, 602 were technically successful (99.8%). Of the 594 patients, 356 had presented with acute pulmonary embolism and/or deep vein thrombosis. A total of 189 filters were retrieved from the 191 patients for whom retrieval had been attempted at 4.3 ± 6.3 months (median, 2.5 months) after placement. The 414 filters without removal procedures had been followed up for 14.8 ± 17.7 months (median, 6.9 months). During the follow-up period, 57 patients (9.5%) had developed new or worsening deep vein thrombosis caudal to the filter and 19 (3.2%) had experienced new symptomatic nonfatal pulmonary embolism after filter placement. One filter had migrated and fractured, and another filter had fractured and a strut was lost. Perforation was demonstrated equivocally in 12 (3%) and definitely in 17 (4.3%) of 399 patients with adequate imaging studies available, with penetration into surrounding structures in 13 patients (3.3%). Of 332 patients with adequate imaging studies, 12 (3.6%) had developed substantial IVC thrombosis and 4 (1.2%) had developed IVC occlusion. CONCLUSIONS The rates of symptomatic pulmonary embolism and filter-related complications were low after OptionELITE IVC filter placement, and filter retrieval, when attempted, was 99% successful.
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Affiliation(s)
- Nathan Albertson
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN.
| | - Mitchell Rice
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Adam Schmitz
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Joseph Eskew
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Paul Haste
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew S Johnson
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
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Haut ER, Byrne JP, Price MA, Bixby P, Bulger EM, Lake L, Costantini T. Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma. J Trauma Acute Care Surg 2023; 94:461-468. [PMID: 36534056 PMCID: PMC9974764 DOI: 10.1097/ta.0000000000003843] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT On May 4 and 5, 2022, a meeting of multidisciplinary stakeholders in the prevention and treatment of venous thromboembolism (VTE) after trauma was convened by the Coalition for National Trauma Research, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and hosted by the American College of Surgeons in Chicago, Illinois. This consensus conference gathered more than 40 in-person and 80 virtual attendees, including trauma surgeons, other physicians, thrombosis experts, nurses, pharmacists, researchers, and patient advocates. The objectives of the meeting were twofold: (1) to review and summarize the present state of the scientific evidence regarding VTE prevention strategies in injured patients and (2) to develop consensus on future priorities in VTE prevention implementation and research gaps.To achieve these objectives, the first part of the conference consisted of talks from physician leaders, researchers, clinical champions, and patient advocates to summarize the current state of knowledge of VTE pathogenesis and prevention in patients with major injury. Video recordings of all talks and accompanying slides are freely available on the conference website ( https://www.nattrauma.org/research/research-policies-templates-guidelines/vte-conference/ ). Following this curriculum, the second part of the conference consisted of a series of small-group breakout sessions on topics potentially requiring future study. Through this process, research priorities were identified, and plans of action to develop and undertake future studies were defined.The 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma answered the National Trauma Research Action Plan call to define a course for future research into preventing thromboembolism after trauma. A multidisciplinary group of clinical champions, physicians, scientists, and patients delineated clear objectives for future investigation to address important, persistent key knowledge gaps. The series of papers from the conference outlines the consensus based on the current literature and a roadmap for research to answer these unanswered questions.
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Affiliation(s)
- Elliott R Haut
- From the Division of Acute Care Surgery, Department of Surgery (E.R.H., J.P.B.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), Johns Hopkins University School of Medicine; Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine; Department of Health Policy and Management (E.R.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Coalition for National Trauma Research (M.A.P., P.B.), San Antonio, Texas; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington, DC; National Blood Clot Alliance (L.L.), Philadelphia, Pennsylvania; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (T.C.), University of California San Diego School of Medicine, San Diego, California
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Johnson MS, Spies JB, Scott KT, Kato BS, Mu X, Rectenwald JE, White RA, Lewandowski RJ, Khaja MS, Zuckerman DA, Casciani T, Gillespie DL. Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months. J Vasc Surg Venous Lymphat Disord 2023; 11:573-585.e6. [PMID: 36872169 DOI: 10.1016/j.jvsv.2022.11.002] [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: 08/31/2022] [Revised: 10/11/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To determine the safety and effectiveness of vena cava filters (VCFs). METHODS A total of 1429 participants (62.7 ± 14.7 years old; 762 [53.3% male]) consented to enroll in this prospective, nonrandomized study at 54 sites in the United States between October 10, 2015, and March 31, 2019. They were evaluated at baseline and at 3, 6, 12, 18, and 24 months following VCF implantation. Participants whose VCFs were removed were followed for 1 month after retrieval. Follow-up was performed at 3, 12, and 24 months. Predetermined composite primary safety (freedom from perioperative serious adverse events [AEs] and from clinically significant perforation, VCF embolization, caval thrombotic occlusion, and/or new deep vein thrombosis [DVT] within 12-months) and effectiveness (composite comprising procedural and technical success and freedom from new symptomatic pulmonary embolism [PE] confirmed by imaging at 12-months in situ or 1 month postretrieval) end points were assessed. RESULTS VCFs were implanted in 1421 patients. Of these, 1019 (71.7%) had current DVT and/or PE. Anticoagulation therapy was contraindicated or had failed in 1159 (81.6%). One hundred twenty-six (8.9%) VCFs were prophylactic. Mean and median follow-up for the entire population and for those whose VCFs were not removed was 243.5 ± 243.3 days and 138 days and 332.6 ± 290 days and 235 days, respectively. VCFs were removed from 632 (44.5%) patients at a mean of 101.5 ± 72.2 days and median 86.3 days following implantation. The primary safety end point and primary effectiveness end point were both achieved. Procedural AEs were uncommon and usually minor, but one patient died during attempted VCF removal. Excluding strut perforation greater than 5 mm, which was demonstrated on 31 of 201 (15.4%) patients' computed tomography scans available to the core laboratory, and of which only 3 (0.2%) were deemed clinically significant by the site investigators, VCF-related AEs were rare (7 of 1421, 0.5%). Postfilter, venous thromboembolic events (none fatal) occurred in 93 patients (6.5%), including DVT (80 events in 74 patients [5.2%]), PE (23 events in 23 patients [1.6%]), and/or caval thrombotic occlusions (15 events in 15 patients [1.1%]). No PE occurred in patients following prophylactic placement. CONCLUSIONS Implantation of VCFs in patients with venous thromboembolism was associated with few AEs and with a low incidence of clinically significant PEs.
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Affiliation(s)
- Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
| | - James B Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | - John E Rectenwald
- Section of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rodney A White
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Heart and Vascular Institute, Long Beach Memorial Care, Long Beach, CA
| | | | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, University of Michigan, Ann Arbor, MI; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Thomas Casciani
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - David L Gillespie
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Brockton, MA
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Johnson MS, Spies JB, Scott KT, Kato BS, Mu X, Rectenwald JE, White RA, Lewandowski RJ, Khaja MS, Zuckerman DA, Casciani T, Gillespie DL. Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months. J Vasc Interv Radiol 2023; 34:517-528.e6. [PMID: 36841633 DOI: 10.1016/j.jvir.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/05/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To determine the safety and effectiveness of vena cava filters (VCFs). METHODS A total of 1429 participants (62.7 ± 14.7 years old; 762 [53.3% male]) consented to enroll in this prospective, nonrandomized study at 54 sites in the United States between October 10, 2015, and March 31, 2019. They were evaluated at baseline and at 3, 6, 12, 18, and 24 months following VCF implantation. Participants whose VCFs were removed were followed for 1 month after retrieval. Follow-up was performed at 3, 12, and 24 months. Predetermined composite primary safety (freedom from perioperative serious adverse events [AEs] and from clinically significant perforation, VCF embolization, caval thrombotic occlusion, and/or new deep vein thrombosis [DVT] within 12-months) and effectiveness (composite comprising procedural and technical success and freedom from new symptomatic pulmonary embolism [PE] confirmed by imaging at 12-months in situ or 1 month postretrieval) end points were assessed. RESULTS VCFs were implanted in 1421 patients. Of these, 1019 (71.7%) had current DVT and/or PE. Anticoagulation therapy was contraindicated or had failed in 1159 (81.6%). One hundred twenty-six (8.9%) VCFs were prophylactic. Mean and median follow-up for the entire population and for those whose VCFs were not removed was 243.5 ± 243.3 days and 138 days and 332.6 ± 290 days and 235 days, respectively. VCFs were removed from 632 (44.5%) patients at a mean of 101.5 ± 72.2 days and median 86.3 days following implantation. The primary safety end point and primary effectiveness end point were both achieved. Procedural AEs were uncommon and usually minor, but one patient died during attempted VCF removal. Excluding strut perforation greater than 5 mm, which was demonstrated on 31 of 201 (15.4%) patients' computed tomography scans available to the core laboratory, and of which only 3 (0.2%) were deemed clinically significant by the site investigators, VCF-related AEs were rare (7 of 1421, 0.5%). Postfilter, venous thromboembolic events (none fatal) occurred in 93 patients (6.5%), including DVT (80 events in 74 patients [5.2%]), PE (23 events in 23 patients [1.6%]), and/or caval thrombotic occlusions (15 events in 15 patients [1.1%]). No PE occurred in patients following prophylactic placement. CONCLUSIONS Implantation of VCFs in patients with venous thromboembolism was associated with few AEs and with a low incidence of clinically significant PEs.
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Affiliation(s)
- Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
| | - James B Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | - John E Rectenwald
- Section of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rodney A White
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Heart and Vascular Institute, Long Beach Memorial Care, Long Beach, CA
| | | | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, University of Michigan, Ann Arbor, MI; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Thomas Casciani
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - David L Gillespie
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Brockton, MA
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Rizzo SM, Tavakol S, Bi WL, Li S, Secemsky EA, Campia U, Piazza G, Goldhaber SZ, Schmaier AA. Meningioma resection and venous thromboembolism incidence, management, and outcomes. Res Pract Thromb Haemost 2023; 7:100121. [PMID: 37063769 PMCID: PMC10099298 DOI: 10.1016/j.rpth.2023.100121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/24/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023] Open
Abstract
Background Meningioma resection is associated with the risk of venous thromboembolism (VTE). Objectives To determine the incidence and risk factors for VTE following meningioma resection and VTE outcomes based on the type and timing of anticoagulation. Methods From 2011 to 2019, 901 consecutive patients underwent meningioma resection. We retrospectively evaluated the postoperative incidence of VTE and bleeding. For VTE, we determined the treatment strategy and rate of VTE complications and bleeding. Results Pharmacologic prophylaxis was administered to 665 (73.8%) patients. The cumulative incidence for total postoperative VTE was 8.7% (95% CI: 6.9%-10.6%), and for symptomatic VTE was 6.0% (95% CI: 4.6%-7.7%). A multivariable model identified the following independent predictors of symptomatic VTE: history of VTE, obesity, and lack of pharmacologic prophylaxis. Following postoperative VTE, 58 (74.3%) patients received therapeutic anticoagulation either initially (33.3%) or after a median delay of 23.5 days (41.0%). Symptomatic recurrent VTE occurred in 13 (16.6%) patients. Following VTE, the use of subtherapeutic anticoagulation was associated with a lower rate of total VTE extension than no anticoagulation (17.5% vs 42.9%, OR 0.28, 95% CI: 0.09-0.93). In total, 14 patients (1.6%) experienced clinically relevant bleeding: 4 received therapeutic anticoagulants, 8 received prophylactic anticoagulation, and 2 received no anticoagulation. Among patients with VTE, 4 (5.1%) experienced bleeding. Conclusion Recognition of risk factors for VTE following meningioma resection may help improve approaches to thromboprophylaxis. The management of postoperative VTE is highly variable, but most VTE patients are ultimately treated with therapeutic anticoagulants.
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Affiliation(s)
- Samantha M. Rizzo
- Brigham and Women’s Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sherwin Tavakol
- Brigham and Women’s Hospital, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Wenya Linda Bi
- Brigham and Women’s Hospital, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Siling Li
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eric A. Secemsky
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umberto Campia
- Brigham and Women’s Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Piazza
- Brigham and Women’s Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Z. Goldhaber
- Brigham and Women’s Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alec A. Schmaier
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Division of Hemostasis and Thrombosis, Harvard Medical School, Boston, Massachusetts, USA
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Vedantham S, Desai KR, Weinberg I, Marston W, Winokur R, Patel S, Kolli KP, Azene E, Nelson K. Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis. J Vasc Interv Radiol 2023; 34:284-299.e7. [PMID: 36375763 DOI: 10.1016/j.jvir.2022.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To establish the updated position of the Society of Interventional Radiology (SIR) on the endovascular management of acute iliofemoral deep vein thrombosis (DVT). MATERIALS AND METHODS A multidisciplinary writing group with expertise in treating venous diseases was convened by SIR. A comprehensive literature search was conducted to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 84 studies, including randomized trials, systematic reviews and meta-analyses, prospective single-arm studies, and retrospective studies were identified and included in the review. The expert writing group developed 17 recommendations that pertain to the care of patients with acute iliofemoral DVT with the use of endovascular venous interventions. CONCLUSIONS SIR considers endovascular thrombus removal to be an acceptable treatment option in selected patients with acute iliofemoral DVT. Careful individualized risk assessment, high-quality general DVT care, and close monitoring during and after procedures should be provided.
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Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - William Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Kanti Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ezana Azene
- Gundersen Health System, La Crosse, Wisconsin
| | - Kari Nelson
- Department of Radiology, Orange Coast Medical Center, Fountain Valley, California
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Stevens H, Bortz H, Chao S, Ramanan R, Clements W, Peter K, McFadyen JD, Tran H. Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement. Res Pract Thromb Haemost 2023; 7:100040. [PMID: 36852111 PMCID: PMC9958400 DOI: 10.1016/j.rpth.2023.100040] [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: 03/30/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices. Objectives To determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism. Methods Ambidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status. Results Overall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06-15.84). Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%-73.5%, respectively; (OR, 2.50; 95% CI, 1.67-3.78). The MDST was associated with a shorter median time-to-filter retrieval (187-150 days, hazard ratio, 1.78; 95% CI, 1.39-2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality. Conclusion Our study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.
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Affiliation(s)
- Hannah Stevens
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Correspondence Hannah Stevens, Department of Clinical Haematology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia. @hannahpstevens
| | - Hadley Bortz
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Sharon Chao
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Radha Ramanan
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia,Department of Surgery, Monash University Central Clinical School, Melbourne, Australia,National Trauma Research Institute, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Department of Cardiology, Alfred Hospital, Melbourne, Melbourne, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - James D. McFadyen
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - Huyen Tran
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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