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Montoya C, Rey J, Polania-Sandoval CA, Bornak A, Shao T, Kenel-Pierre S. Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review. Vasc Endovascular Surg 2024; 58:559-566. [PMID: 38196287 DOI: 10.1177/15385744231226048] [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: 01/11/2024]
Abstract
INTRODUCTION AND IMPORTANCE Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. CASE PRESENTATION A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. CLINICAL FINDINGS AND INVESTIGATIONS The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. INTERVENTION AND OUTCOMES The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. RELEVANCE AND IMPACT Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jorge Rey
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | | | - Arash Bornak
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Tony Shao
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Stefan Kenel-Pierre
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
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Choi PJ, Kabeil M, Furtado Neves PJ, Labropoulos N, Zil-E-Ali A, Aziz F, Malgor EA, Malgor RD. Urological complications caused by inferior vena cava filters: a systematic review. INT ANGIOL 2024; 43:247-254. [PMID: 38619204 DOI: 10.23736/s0392-9590.24.05041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review. EVIDENCE ACQUISITION A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication. EVIDENCE SYNTHESIS Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported. CONCLUSIONS Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.
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Affiliation(s)
- Paul J Choi
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Pedro J Furtado Neves
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Ahsan Zil-E-Ali
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Faisal Aziz
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Emily A Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Rafael D Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, 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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Qi YH, Wang T, Wang J, Yuan D. Inferior vena cava filter reduces pulmonary embolism but does not increase deep venous thrombosis: A systematic review and meta-analysis. Asian J Surg 2021; 45:592-593. [PMID: 34815146 DOI: 10.1016/j.asjsur.2021.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu-Han Qi
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Li T, Dong S, Zhang Z, Yang J. Hazardous Situation During Conversion of a Long-term Indwelling VenaTech Convertible Inferior Vena Cava Filter. Ann Vasc Surg 2021; 76:600.e19-600.e22. [PMID: 34175414 DOI: 10.1016/j.avsg.2021.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A lack of high-quality research and data has restricted the comprehensive understanding of the conversion procedure of convertible inferior vena cava filters. The aim of this study was to present an unusual situation with a high risk of causing complication, during conversion of VenaTech convertible inferior vena cava filter and our management procedure. METHODS Lower extremity deep venous thrombi were detected in a 62-year-old woman before major orthopedic surgery. A VenaTech convertible inferior vena cava filter was placed to prevent possible pulmonary embolism and 106 days later, the filter was converted without any complications. RESULTS At the 6-month follow-up, no adverse events were reported. CONCLUSIONS The long-term indwelling of a filter might increase the complexity and uncertainty of the conversion procedure. This report presented a rare but hazardous situation during conversion and our management procedure.
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Affiliation(s)
- Tao Li
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuilin Dong
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Zhiwei Zhang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Lee J, Roche-Nagle G. Permanent IVC filter strut penetration into an abdominal aortic aneurysm. BMJ Case Rep 2021; 14:14/6/e241962. [PMID: 34099449 DOI: 10.1136/bcr-2021-241962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 85-year-old man with a known history of abdominal aortic aneurysm (AAA) presented to a vascular surgery clinic with a severely swollen, tender and erythematous left leg. An urgent CT angiogram demonstrated a left-sided, proximal deep vein thrombosis, and a permanent, Bird's Nest inferior vena cava (IVC) filter (Cook, Inc., Bloomington, Ind.) penetrating his AAA. The patient was treated with a course of apixaban 5 mg two times per day and the decision was made to closely observe his IVC filter and AAA, given his numerous comorbidities and age. This case highlights the unique considerations associated with an approach to permanent IVC filter complications among patients with AAAs.
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Affiliation(s)
- Juehea Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Khan W, Zhang W, Clark V. Persistent Abdominal Pain as Rare Complication of Duodenal Perforation From an Inferior Vena Cava Filter. Cureus 2021; 13:e13168. [PMID: 33717717 PMCID: PMC7939541 DOI: 10.7759/cureus.13168] [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] [Indexed: 11/05/2022] Open
Abstract
Deep vein thrombosis (DVT) continues to be a significant source of morbidity for surgical patients. Inferior vena cava (IVC) filter placement is indicated for DVT in patients who have contraindications to anticoagulation or anticoagulation failure. Over the last decade, there is an exponential increase in IVC filter placement with increased complications reported. These include IVC penetration, IVC occlusion, insertion complication and filter migration. We report a rare case of symptomatic duodenal perforation by an IVC filter migration. This case illustrates that even though IVC migration and perforation is a rare complication, it should be recognized as a potential cause for gastrointestinal (GI) symptoms in these patients.
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Affiliation(s)
- Walid Khan
- Department of Internal Medicine, University of Florida, Gainesville, USA
| | - Wei Zhang
- Department of Gastroenterology and Hepatology, University of Florida, Gainesville, USA
| | - Virginia Clark
- Department of Gastroenterology and Hepatology, University of Florida, Gainesville, USA
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Gwon JG. Structural Injury of Adjacent Organs Due to Inferior Vena Cava Filter Penetration. Phlebology 2020. [DOI: 10.37923/phle.2020.18.3.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jun Gyo Gwon
- Department of Transplantation and Vascular Surgery, Korea University Anam Hospital, Seoul, Korea
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Elkbuli A, Ehrhardt JD, Kinslow K, McKenney M. Timing of Prophylactic Inferior Vena Cava Filter Placement and Trauma Outcomes : Does Early Placement Matter? Am Surg 2020; 86:1741-1747. [PMID: 32902319 DOI: 10.1177/0003134820949993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prophylactic inferior vena cava filters (IVCFs) are often placed in trauma patients who cannot receive prophylactic anticoagulation. IVCFs are utilized in an effort to reduce the risk of acute pulmonary embolism (PE) and mortality. This study aims to investigate whether time-to-filter placement is associated with differences in trauma outcomes. METHODS We conducted a single-center retrospective review of adult trauma patients who underwent prophylactic IVCF placement. Patients were divided into 2 groups based on time-to-filter: 0-48 hours and >48 hours. Outcome measures included post-filter deep vein thrombosis (DVT), post-filter PE, in-hospital mortality, and ICU length of stay (ICU-LOS). Significance was defined as P < .05. RESULTS During the 6-year study period, 513 patients underwent prophylactic IVCF placement. Both groups were similar with respect to injury severity score (ISS) (P = .540), percent of patients on home anticoagulation (38% and 39%, P = .845), abbreviated injury scale (AIS) by anatomic region (P = .899), and traumatic brain injury (TBI) prevalence (P = .182). Time-to-filter was not associated with significant differences in DVT, PE, or in-hospital mortality (P > .05 for all). Filter placement in the first 48 hours was associated with shorter ICU-LOS and hospital-LOS. CONCLUSIONS Currently, there are no investigations in the trauma literature looking at the impact of time-to-filter on complications related to venous thromboembolism and potential survival benefit. Results of this investigation showed that IVCF placement within the first 48 hours was significantly associated with shorter ICU- and hospital- LOS.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Divison of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - John D Ehrhardt
- Department of Surgery, Divison of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kyle Kinslow
- Department of Surgery, Divison of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Divison of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Costs and complications of hospital admissions for inferior vena cava filter malfunction. J Vasc Surg Venous Lymphat Disord 2020; 9:315-320.e4. [PMID: 32791305 DOI: 10.1016/j.jvsv.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Inferior vena cava filter (IVCF) malfunction can result from penetration, fracture, or migration of the device necessitating retrieval. Endovascular and open retrieval of IVCF have been described in institutional series without comparison. This study examines national hospital admissions for IVCF malfunction and compares the outcomes of open and endovascular retrieval. METHODS The National Inpatient Sample database (2016-2017) was reviewed for admissions with International Classification of Diseases, Tenth Revision (ICD-10) codes specific for IVCF malfunction. All ICD-10 procedural codes were reviewed, and patients were divided based on open or endovascular IVCF retrieval. Patient characteristics, outcomes, and costs of hospitalization were compared between the two groups. RESULTS There were 665 patients admitted with a diagnosis of IVCF malfunction. Open IVCF retrieval was performed in 100 patients and endovascular removal in 90 patients. Of those undergoing open surgery, 45 patients (45%) required median sternotomy and 55 (55%) required abdominal surgeries. Most patients were white females with a mean age of 54.4 years (range, 49.3-59.6 years) with a history of deep venous thrombosis (55.3%) or pulmonary embolism (31.6%). Most patients with IVCF malfunction were treated in large (81.6%) or urban teaching (94.7%) hospitals situated most commonly in the South (42.1%) and Northeast (29.0%) with no difference in characteristics of the patients or the centers between the two groups. Patients undergoing open IVCF retrieval were more likely to undergo surgery on an elective basis compared with endovascular IVCF retrieval (75.0% vs 11.1%; P < .001). Open IVCF retrieval was associated with a higher likelihood of thromboembolic complication compared with endovascular retrieval (20% vs 0%; P = .04). There was a trend toward higher infectious complications and overall complications with endovascular removal, but this difference did not reach statistical significance. Open retrieval was associated with a mortality of 5.0% compared with no inpatient mortality with endovascular retrieval (P = .33). The mean hospital length of stay was no difference between the two groups. Open retrieval was associated with significantly higher hospital costs than endovascular retrieval ($34,276 vs $19,758; P = .05). CONCLUSIONS Filter removal for patients with IVCF malfunction is associated with significant morbidity and cost, regardless of modality of retrieval. The introduction of specific ICD-10 codes for IVCF malfunction allows researchers to study these events. The development of effective tools for outpatient retrieval of malfunctioning IVCF could decrease related hospitalization and have potential savings for the healthcare system.
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Qato K, Conway A, Fatakhova O, Nguyen N, Giangola G, Carroccio A. Various Approaches to Open Removal of Inferior Vena Cava Filters. Ann Vasc Surg 2020; 65:288.e9-288.e14. [DOI: 10.1016/j.avsg.2019.11.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022]
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12
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Krutman M, Yazbek G, Nishinari K, Pignataro BS, Bomfim GAZ, Cavalcante RN, Centofanti G, Fonseca IYI. An alternative approach to treatment of inferior vena cava filter perforation. J Vasc Bras 2020; 19:e20180131. [PMID: 34178046 PMCID: PMC8202168 DOI: 10.1590/1677-5449.180131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract We report a case of inferior vena cava filter perforation immediately after filter implantation, recognized intraoperatively in a patient undergoing laparotomy for resection of locally advanced ovarian cancer. We describe an alternative approach with strut resection, less invasive than filter removal, enabling the device to be maintained and bleeding to be controlled.
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Forceps-assisted Removal of Difficult-to-Retrieve Filters: Preliminary Results. Ann Vasc Surg 2019; 61:371-376. [PMID: 31394218 DOI: 10.1016/j.avsg.2019.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study is to retrospectively evaluate the safety and effectiveness of forceps-assisted removal of difficult-to-retrieve filters. METHODS Patients who underwent forceps-assisted removal of difficult-to-retrieve filters (filters that could not be successfully removed with the standard loop-snare technique) between February 2008 and February 2019 were included in this study. Patients underwent forceps-assisted filter removal either immediately after failed loop-snare removal (same procedure) or at a later time (separate procedure). Data regarding success rate, X-ray exposure time, and complications were recorded. RESULTS A total of 27 patients (14 men, 13 women; mean age 57.9 ± 12.6 years) were included in this study. The mean indwelling time of the filters was 10.9 ± 10.7 months. All filters were successfully removed. The mean X-ray exposure time was 25.9 ± 12.7 min (range 8-55) for all patients; the mean X-ray exposure times were 10.2 ± 2.3 min (range 8-14) for the 5 patients who underwent forceps-assisted filter removal in a separate procedure and 29.5 ± 11.2 min (range 15-55) for the 22 patients who underwent forceps-assisted filter removal immediately after failure of the loop-snare technique (P < 0.001). Two patients (8.3%) experienced extravasation of contrast material and needed no additional treatment. No major complications occurred. CONCLUSIONS Forceps-assisted filter retrieval can be used to safely and effectively remove difficult-to-retrieve filters.
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Ansari D, Torén W, Lindberg S, Pyrhönen HS, Andersson R. Diagnosis and management of duodenal perforations: a narrative review. Scand J Gastroenterol 2019; 54:939-944. [PMID: 31353983 DOI: 10.1080/00365521.2019.1647456] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - William Torén
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Sarah Lindberg
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Helmi-Sisko Pyrhönen
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Roland Andersson
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
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Chassin-Trubert L, Prouse G, Ozdemir BA, Lounes Y, Alonso W, Clapiès M, Alric P, Canaud L. Filter-Associated Inferior Vena Cava Thrombosis with Duodenal Perforation: Case Report and Literature Review. Ann Vasc Surg 2019; 58:383.e1-383.e6. [DOI: 10.1016/j.avsg.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 12/01/2022]
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16
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Ahmed O, Hieromnimon M, Weber CR, Wang CX, Tullius T. Appendicitis Secondary to a Fractured, Penetrating Celect IVC Filter in a Young Kidney Transplant Recipient. J Vasc Interv Radiol 2019; 30:963-965. [PMID: 31126608 DOI: 10.1016/j.jvir.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Osman Ahmed
- Department of Interventional Radiology, University of Chicago, 1725 West Harrison Street, Suite 450, Chicago, IL 60612
| | - Mark Hieromnimon
- Department of Interventional Radiology, University of Chicago, 1725 West Harrison Street, Suite 450, Chicago, IL 60612
| | - Christopher R Weber
- Department of Interventional Radiology, University of Chicago, 1725 West Harrison Street, Suite 450, Chicago, IL 60612
| | - Cindy X Wang
- Department of Interventional Radiology, University of Chicago, 1725 West Harrison Street, Suite 450, Chicago, IL 60612
| | - Thomas Tullius
- Department of Interventional Radiology, University of Chicago, 1725 West Harrison Street, Suite 450, Chicago, IL 60612
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17
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Affiliation(s)
- Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Japan
| | - Ryoichi Harada
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Akiko Fujiwara
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
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18
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Shimizu T, Kubota K, Suzuki T, Matsumoto T, Shiraki T, Sakuraoka Y, Mori S, Iso Y, Kato M, Ishizuka M, Aoki T. A technique for taping inferior vena cava caudal to the duodenum: duodenal penetration by IVC filter strut after retroperitoneal lymph node dissection-usefulness of the mesenteric approach. Surg Case Rep 2019; 5:69. [PMID: 31020425 PMCID: PMC6482199 DOI: 10.1186/s40792-019-0626-5] [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: 12/01/2018] [Accepted: 04/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although an inferior vena cava (IVC) filter is used for preventing pulmonary thromboembolism (PTE) in patients with deep vein thrombosis, IVC filter penetration in the duodenum is a rare complication. Case presentation A 35-year-old man had previously undergone retroperitoneal lymph node dissection (RPLND) for testicular cancer and IVC filter placement for prevention of PTE. Esophagogastroduodenoscopy (EGD) for his epigastric pain revealed penetration of the IVC filter in the duodenum. The IVC filter was retrieved through cavotomy, and the duodenal penetration was repaired using EGD clipping. Although it was difficult to mobilize the duodenum due to adhesion resulting from RPLND, the use of a mesenteric approach enabled encircling of the IVC caudal to the duodenum. The mesenteric approach is useful and safe for taping the IVC caudal to the duodenum in cases where it is difficult to mobilize the duodenum. Conclusion IVC taping using the mesenteric approach allowed safe retrieval of the IVC filter after RPLND without postoperative complications.
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Affiliation(s)
- Takayuki Shimizu
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takashi Suzuki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takatsugu Matsumoto
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takayuki Shiraki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yuhki Sakuraoka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shozo Mori
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yukihiro Iso
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Masato Kato
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Mitsuru Ishizuka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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19
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Jia Z, Fuller TA, McKinney JM, Paz-Fumagalli R, Frey GT, Sella DM, Van Ha T, Wang W. Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications. Cardiovasc Intervent Radiol 2018; 41:675-682. [PMID: 29359241 DOI: 10.1007/s00270-018-1880-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval. METHODS A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016. RESULTS A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n = 6270; 56.3%) and prophylactic (n = 4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6 ± 47.3 days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively. CONCLUSIONS Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.
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Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, China
| | - Tyler A Fuller
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, 34211, USA
| | - J Mark McKinney
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ricardo Paz-Fumagalli
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Gregory T Frey
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David M Sella
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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20
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Bond JM, Wayne E, Dwivedi AJ, Sigdel A. Successful Percutaneous Retrieval of IVC Filter with Wide Retroperitoneal Penetration Presenting with Gastrointestinal Bleeding. Ann Vasc Dis 2017. [PMID: 29515711 PMCID: PMC5835423 DOI: 10.3400/avd.cr.17-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Symptomatic penetration of the retroperitoneal structures by inferior vena cava (IVC) filter is a rare clinical entity. Vast majority of these patients require laparotomy and open retrieval of the filter. We report a case of a filter penetrating into the duodenum within two months of implantation resulting in gastrointestinal bleeding. The patient was successfully managed with percutaneous retrieval of the filter, blood transfusion and serial abdominal examination thus avoiding laparotomy.
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Affiliation(s)
- Jordan M Bond
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Erik Wayne
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Amit J Dwivedi
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Abindra Sigdel
- Department of Surgery, University of Louisville, Kentucky, USA
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21
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Desai KR, Pandhi MB, Seedial SM, Errea MF, Salem R, Ryu RK, Lewandowski RJ. Retrievable IVC Filters: Comprehensive Review of Device-related Complications and Advanced Retrieval Techniques. Radiographics 2017; 37:1236-1245. [PMID: 28696849 DOI: 10.1148/rg.2017160167] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of retrievable inferior vena cava filters (RIVCFs) has grown exponentially since their introduction into clinical practice, but many of these devices are not retrieved. Some are not retrieved due to poor clinical follow-up, but other devices remain in situ for extended periods because they present significant technical challenges during retrieval. Because of these and other factors, many of these devices were thus left in place permanently. However, recent data have placed a renewed emphasis on device retrieval due to increased risk of RIVCF-related complications, which are positively correlated with filter dwell time. Development of advanced filter retrieval techniques has had a significant impact on the removal of embedded RIVCFs, permitting retrieval of the majority of devices. The purpose of this article is to present an imaging and data review of the dominant device-related factors that complicate RIVCF retrieval and to describe the relevant advanced retrieval techniques to manage these factors. RIVCF imaging is frequently encountered in daily clinical practice via various imaging modalities. Therefore, diagnostic radiologists can play a vital role in identifying filter-related issues. Familiarity with the context for managing these issues in the interventional suite is essential for improving triage and care of patients with RIVCFs. © RSNA, 2017.
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Affiliation(s)
- Kush R Desai
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Mithil B Pandhi
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Stephen M Seedial
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Martin F Errea
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Riad Salem
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert K Ryu
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
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22
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Bikdeli B, Chatterjee S, Desai NR, Kirtane AJ, Desai MM, Bracken MB, Spencer FA, Monreal M, Goldhaber SZ, Krumholz HM. Inferior Vena Cava Filters to Prevent Pulmonary Embolism: Systematic Review and Meta-Analysis. J Am Coll Cardiol 2017; 70:1587-1597. [PMID: 28935036 DOI: 10.1016/j.jacc.2017.07.775] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) filters are widely used for prevention of pulmonary embolism (PE). However, uncertainty persists about their efficacy and safety. OBJECTIVES The authors conducted a systematic review and meta-analysis of the published reports on the efficacy and safety of IVC filters. METHODS The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through October 3, 2016, for randomized controlled trials (RCTs) or prospective controlled observational studies of IVC filters versus none in patients at risk of PE. Inverse variance fixed-effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes included subsequent PE, PE-related mortality, all-cause mortality, and subsequent deep vein thrombosis (DVT). RESULTS The authors' search retrieved 1,986 studies, of which 11 met criteria for inclusion (6 RCTs and 5 prospective observational studies). Quality of evidence for RCTs was low to moderate. Overall, patients receiving IVC filters had lower risk for subsequent PE (OR: 0.50; 95% confidence interval [CI]: 0.33 to 0.75); increased risk for DVT (OR: 1.70; 95% CI: 1.17 to 2.48); nonsignificantly lower PE-related mortality (OR: 0.51; 95% CI: 0.25 to 1.05); and no change in all-cause mortality (OR: 0.91; 95% CI: 0.70 to 1.19). Limiting the results to RCTs showed similar results. Findings were substantively similar across a wide range of sensitivity analyses. CONCLUSIONS Very few prospective controlled studies, with limited quality of evidence, exist regarding the efficacy and safety of IVC filters. Overall, filters appear to reduce the risk of subsequent PE, increase the risk for DVT, and have no significant effect on overall mortality.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
| | | | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Mayur M Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Michael B Bracken
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Frederick A Spencer
- Divisions of Cardiology and Hematology & Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Manuel Monreal
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Samuel Z Goldhaber
- Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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23
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Baptista Sincos APW, Sincos IR, Labropoulos N, Donegá BC, Klepacz A, Aun R. Symptomatic duodenal perforation by inferior vena cava filter. Phlebology 2017; 33:523-533. [DOI: 10.1177/0268355517731049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments. Method The reference list of Malgor’s review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Results Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative. Conclusion Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.
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Affiliation(s)
| | - Igor R Sincos
- Department of Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nicos Labropoulos
- Department of Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno C Donegá
- Department of Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea Klepacz
- Department of Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ricardo Aun
- Department of Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
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24
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Fernandez-Moure JS, Kim K, Zubair MH, Rosenberg WR. Case report on the non-operative management of a retrievable inferior vena cava filter perforating the duodenum. Int J Surg Case Rep 2017; 39:60-63. [PMID: 28806622 PMCID: PMC5554988 DOI: 10.1016/j.ijscr.2017.06.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Deep vein thrombosis (DVT) continues to be a significant source of morbidity for surgical patients. Placement of a retrievable inferior vena cava (IVC) filter is used when patients have contraindications to anticoagulation or recurrent pulmonary embolism despite therapeutic anticoagulation. Although retrievable IVC filters are often used, they carry a unique set of risks. PRESENTATION OF CASE A 67-year-old man presents to the Emergency Room (ER) following large volume melena and complaining of syncope. One year prior, the patient had been diagnosed with Glioblastoma multiforme, for which he underwent a craniotomy with near-total resection of the mass. He subsequently developed a deep vein thrombosis and underwent placement of a retrievable inferior vena cava (IVC) filter. Computerized tomography (CT) and esophagogastroduodenoscopy showed duodenal perforation by the retrievable IVC filter. The filter was successfully retrieved through an endovascular approach. DISCUSSION Retrievable IVC filter placement is the preferred method of pulmonary embolism prevention in patients with significant risk for bleeding. Duodenal perforation by a retrievable IVC filter is a rare and serious complication. It is usually managed surgically, but can also be managed non-operatively. CONCLUSION For patients with significant comorbidities or patients who are poor surgical candidates, non-operative management with close monitoring can serve as an initial approach to the patient with a caval enteric perforation secondary to a retrievable IVC filter.
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Affiliation(s)
- Joseph S Fernandez-Moure
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States; Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, United States
| | - Keemberly Kim
- Texas A&M College of Medicine, 8447 TX-47, Bryan, TX 77807, United States
| | - M Haseeb Zubair
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States
| | - Wade R Rosenberg
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States.
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25
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Workman CS, Lewandowski RJ, Desai KR. Techniques for Retrieval of Permanent Inferior Vena Cava Filters. Semin Intervent Radiol 2017; 34:208-212. [PMID: 28607530 DOI: 10.1055/s-0037-1602597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cayce S Workman
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kush R Desai
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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26
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Indications and Outcomes of Open Inferior Vena Cava Filter Removal. Ann Vasc Surg 2017; 46:205.e5-205.e11. [PMID: 28602896 DOI: 10.1016/j.avsg.2017.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make percutaneous retrieval more difficult. Open IVC filter removal is generally reserved for patients with symptoms referable to the filter, such as chronic back and abdominal pain. We present our management algorithm and review of cases of open IVC filter removal. METHODS Patients referred for management of implanted IVC filters from May 2010 to May 2016 were included. Demographic and imaging were reviewed for cases requiring open surgical removal. RESULTS There were 221 percutaneous retrieval attempts in 218 patients. Successful retrieval occurred in 196 (89%) attempts. There were 7 patients who had open surgical IVC filter removal after failure of percutaneous retrieval. One patient had 2 filters and another had 3 filters. Except for 1 case with complications during the percutaneous retrieval procedure, the remaining patients all suffered from back or abdominal pain. All had significant filter strut penetration through the caval wall into adjacent structures. Postoperatively, all patients had relief of pain. There were no deaths and 1 patient had a minor ileus that spontaneously resolved. CONCLUSIONS Patients who fail percutaneous IVC filter retrieval can expect low morbidity and prompt resolution of symptoms after open surgical removal via minilaparotomy.
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27
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Karp JK, Desai KR, Salem R, Ryu RK, Lewandowski RJ. A Dedicated Inferior Vena Cava Filter Service Line: How to Optimize Your Practice. Semin Intervent Radiol 2016; 33:105-8. [PMID: 27247479 DOI: 10.1055/s-0036-1582122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite the increased placement of retrievable inferior vena cava filters (rIVCFs), efforts to remove these devices are not commensurate. The majority of rIVCFs are left in place beyond their indicated usage, and often are retained permanently. With a growing understanding of the clinical issues associated with these devices, the United States Food and Drug Administration (FDA) has prompted clinicians to remove rIVCF when they are no longer indicated. However, major obstacles exist to filter retrieval, chief among them being poor clinical follow-up. The establishment of a dedicated IVC filter service line, or clinic, has been shown to improve filter retrieval rates. Usage of particular devices, specifically permanent versus retrievable filters, is enhanced by prospective physician consultation. In this article, the rationale behind a dedicated IVC filter service line is presented as well as described the structure and activities of the authors' IVC filter clinic; supporting data will also be provided when appropriate.
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Affiliation(s)
- Jennifer K Karp
- Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kush R Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert K Ryu
- Department of Radiology, Section of Interventional Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Pokharel S, Bartholomew C, Zau Z. Duodenal perforation by an inferior vena cava filter with staphylococcal bacteremia: a case report. J Med Case Rep 2016; 10:111. [PMID: 27145864 PMCID: PMC4857254 DOI: 10.1186/s13256-016-0901-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inferior vena cava filter complications can range from dislodgement to perforation. Patients who present with concomitant bacteremia have rarely been reported. Persistent bacteremia usually results from direct bacterial seeding from a source other than perforation of surrounding viscus. It is unclear if the risk of perforation is higher in patients who are bacteremic due to other causes. CASE PRESENTATION We report an interesting case of a 67-year-old white woman who presented with fever, chills, and right upper quadrant abdominal pain. Her blood cultures were positive for methicillin-sensitive Staphylococcus aureus with no obvious source. Upon further investigation, she was found to have an inferior vena cava filter perforating her duodenum. The cause of her abdominal pain was explained by the inferior vena cava filter penetrating the duodenum; however, the source of bacteremia could not be ascertained. The inferior vena cava filter was removed successfully, and she was discharged on an intravenous antibiotic. Her symptoms resolved soon after the filter was removed. CONCLUSIONS The use of inferior vena cava filters has increased significantly in recent years. This is likely due to their wider availability and safer placement techniques. With increasing use, the complications arising from these filters have been on the rise as well. It is very important for clinicians to be aware of these complications to avoid delays in diagnosis and patient care.
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Affiliation(s)
- Sunil Pokharel
- Department of Medicine, Albany Medical Center, 47 New Scotland Avenue, Mail Code 17, Albany, NY, 12208, USA.
| | - Catherine Bartholomew
- Department of Gastroenterology, Albany Medical Center, 47 New Scotland Avenue, Mail Code 48, Albany, NY, 12208, USA
| | - Zing Zau
- Department of Medicine, Albany Medical Center, 47 New Scotland Avenue, Mail Code 17, Albany, NY, 12208, USA
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Jia Z, Wu A, Tam M, Spain J, McKinney JM, Wang W. Caval Penetration by Inferior Vena Cava Filters. Circulation 2015; 132:944-52. [DOI: 10.1161/circulationaha.115.016468] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 07/06/2015] [Indexed: 12/18/2022]
Abstract
Background—
Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.
Methods and Results—
The MEDLINE database was searched for all studies (1970–2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.
Conclusions—
Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.
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Affiliation(s)
- Zhongzhi Jia
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
| | - Alex Wu
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
| | - Mathew Tam
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
| | - James Spain
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
| | - J. Mark McKinney
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
| | - Weiping Wang
- From Department of Interventional Radiology, No. 2 People’s Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.)
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Genovese EA, Jeyabalan G, Marone LK, Avgerinos ED, Makaroun MS, Chaer RA. Endovascular management of symptomatic gastrointestinal complications associated with retrievable inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2015; 3:276-82. [DOI: 10.1016/j.jvsv.2015.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/15/2015] [Indexed: 02/03/2023]
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Kim HK, Song I, Jang JH, Oh CW, Lee JM, Huh S. Outcomes of retrievable inferior vena cava filters in patients with deep vein thrombosis and transient contraindication for anticoagulation. Ann Surg Treat Res 2015; 89:30-6. [PMID: 26131442 PMCID: PMC4481029 DOI: 10.4174/astr.2015.89.1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/14/2015] [Accepted: 03/10/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the efficacy of a retrievable inferior vena cava filter (IVCF) for patients with deep vein thrombosis (DVT) and transient contraindication for anticoagulant therapy, and to analyze the risk factors for filter thrombus in these patients. Methods We retrospectively reviewed the records of 70 patients who received a retrievable IVCF from January 2007 to June 2014 because of documented DVT and transient contraindication for anticoagulant therapy. The protocol for follow-up care generally consisted of anticoagulant therapy after high-risk periods, follow-up CT around 2 weeks after IVCF placement, and retrieval if possible. Results The 70 patients had a mean age of 61.8 years (range, 17-88 years), and 30 were male (43%). The indications for IVCF were recent trauma including surgery in 48 patients, recent hemorrhage in 14, and planned major surgery with DVT in 8 patients. Follow-up CT of 61 patients (87%) was performed. Aggravation or new development of pulmonary embolism (PE) was not found in any patient. Filter thrombus was detected in 23% of patients with follow-up CT (14/61). Filter thrombus was not detected in patients with isolated calf vein thrombosis (ICVT) (P = 0.079). The risk factor for filter thrombus was DVT progression on follow-up CT (P = 0.007) on multivariate analysis. Conclusion For patients with DVT and transient contraindication for anticoagulant therapy, a retrievable IVCF could prevent the aggravation or new development of PE. DVT progression on follow-up CT was associated with filter thrombus and ICVT was not related to filter thrombus in the present study.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Incheol Song
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ji-Hoon Jang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Min Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Jehangir A, Rettew A, Shaikh B, Bennett K, Jehangir Q, Qureshi A, Arshad S, Spiegel A. IVC filter perforation through the duodenum found after years of abdominal pain. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:292-5. [PMID: 25979859 PMCID: PMC4447199 DOI: 10.12659/ajcr.893541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 67 Final Diagnosis: IVC filter perforation through duodenum Symptoms: Abdominal pain Medication: — Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Asad Jehangir
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Andrew Rettew
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Bilal Shaikh
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Kyle Bennett
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Qasim Jehangir
- Department of Internal Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Anam Qureshi
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sharjeel Arshad
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Adam Spiegel
- Department of Gastroenterology, Digestive Disease Associates, Wyomissing, PA, USA
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Open surgical removal of retained and dislodged inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2015; 3:201-6. [DOI: 10.1016/j.jvsv.2014.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 11/18/2014] [Indexed: 11/23/2022]
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Avery A, Stephens M, Redmond K, Harper J. Initial experience using the rigid forceps technique to remove wall-embedded IVC filters. J Med Imaging Radiat Oncol 2015; 59:306-11. [DOI: 10.1111/1754-9485.12299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 02/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Allan Avery
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Maximilian Stephens
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Kendal Redmond
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - John Harper
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
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Dat A, McCann A, Quinn J, Yeung S. Duodenal perforation by an inferior vena cava filter in a polyarteritis nodosa sufferer. Int J Surg Case Rep 2014; 5:1164-6. [PMID: 25437665 PMCID: PMC4275850 DOI: 10.1016/j.ijscr.2014.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 11/08/2014] [Accepted: 11/08/2014] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Inferior vena cava (IVC) filters are currently used in the management of pulmonary embolism (PE) and lower limb venous thromboembolism (VTE). Despite their widespread use, associated complications including duodenal perforation have been reported. PRESENTATION OF CASE We describe a unique case of duodenal perforation 2 years post IVC filter insertion in a patient with polyarteritis nodosa (steroid dependent) and thrombocytopenia secondary to chronic cyclophosphamide use. DISCUSSION IVC filters are commonly employed in the management of VTE. Associated complications have been reported including filter migration, fracture and adjacent organ perforation. There is growing consensus that temporary IVC filters should be retrieved as soon as possible with dedicated IVC filter registries to ensure patients are not lost to follow-up post insertion. CONCLUSION Duodenal perforation is a rare complication of IVC filter insertion. This case however illustrates the potentially catastrophic consequences of a relatively common endovascular procedure. Caution should be taken when considering the insertion of IVC filters in patients with longstanding vasculopathies who are on immunosuppressants.
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Affiliation(s)
- Anthony Dat
- Department of Surgery, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia.
| | - Andrew McCann
- Department of Vascular Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia
| | - John Quinn
- Department of Vascular Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia
| | - Shinn Yeung
- Department of Hepatopancreaticobiliary Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia
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Ouriel K, Fowl RJ, Davies MG, Forbes TL, Gambhir RP, Ricci MA. Disease-specific guidelines for reporting adverse events for peripheral vascular medical devices. J Vasc Surg 2014; 60:212-25. [DOI: 10.1016/j.jvs.2014.04.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/27/2014] [Indexed: 11/28/2022]
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Asymptomatic Duodenal Perforation from an Inferior Vena Cava Filter. ACG Case Rep J 2014; 1:143-4. [PMID: 26157855 PMCID: PMC4435296 DOI: 10.14309/crj.2014.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/16/2014] [Indexed: 11/17/2022] Open
Abstract
Recent exponential increase in inferior vena cava (IVC) filter placements has led to a higher rate of filter complications. A 46-year-old man with a past history of IVC filter placement for bilateral deep vein thrombosis presented with lower abdominal pain. Imaging studies demonstrated IVC filter strut penetrations into multiple structures. Upper endoscopy confirmed an uncomplicated single IVC filter strut penetration into the duodenal wall. The abdominal pain was determined to be unrelated to IVC filter strut penetration, and the patient was managed conservatively. Although IVC filter strut penetrations can cause significant complications, current guidelines remain unclear for management of asymptomatic enteric IVC filter strut penetrations.
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Penetration of the inferior vena cava and adjacent organs after filter placement is associated with retrievable filter type and length of time in place. J Vasc Surg Venous Lymphat Disord 2014; 2:174-8. [PMID: 26993184 DOI: 10.1016/j.jvsv.2013.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/12/2013] [Accepted: 12/02/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Concern over local complications of inferior vena cava (IVC) filters exists, but little long-term data are available. Referrals for filter penetrations on computed tomography (CT) have increased with no standards for management. We reviewed postfilter CT findings in our institution. METHODS All patients receiving IVC filters between January 1, 2006 and December 31, 2009 with a postfilter CT were reviewed. Penetration was graded with a previously published scale. Filter indication, type, and subsequent encounters for abdominal or back pain were recorded. RESULTS A total of 591 patients had a filter during the study period. Of these, 262 had an adequate postfilter CT, comprising the study group. Indications were prophylaxis in 16.4% and venous thromboembolism in 83.6%. Of filters placed for venous thromboembolism, indications were absolute (inability/failure of anticoagulation) in 44.7% and relative in 55.3%. Retrievable filters made up 92.7% of the filters, and 7.3% were permanent type. Of the retrievable filters, 1.6% were retrieved. One hundred twenty (45.8%) filters had grade 2 or 3 penetration. Another 38.2% (100) had struts immediately adjacent to the external aspect of the IVC, which may represent tenting of the cava. Grade 2 or 3 penetration occurred in 49.0% of retrievable filters but only 5.3% of permanent filters (P = .0001). Grade 2 or 3 penetration occurred in 18.2% of filters less than 30 days old but in 57.3% of filters 30 days old or older (P < .0001). Thirty-two patients had subsequent encounters for abdominal or back pain, but none was conclusively related to penetration. CONCLUSIONS A majority of filters were placed for prophylaxis or relative indications and were retrievable type. Retrieval rate was low. Penetration of the IVC and adjacent organs was common and associated with retrievable type and length of time in place. It is unclear if most penetrations cause problems. Monitoring of penetrations with CT may be important to understand the natural history of this condition.
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Penetration of Celect Inferior Vena Cava Filters: Retrospective Review of CT Scans in 265 Patients. AJR Am J Roentgenol 2014; 202:643-7. [DOI: 10.2214/ajr.13.11097] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vyas A, Malas A, Marshall G, Harb A, Stawick L, Svinarich D. Duodenal perforation by an IVC filter: a case and discussion expanding on the 2010 guidelines for filter retrieval. Cardiovasc Intervent Radiol 2013; 37:847-9. [PMID: 24196268 DOI: 10.1007/s00270-013-0754-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 09/09/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Ashish Vyas
- Department of Radiology, Providence Hospital and Medical Center, 16001 W 9 Mile Rd., Southfield, MI, 48075, USA,
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Georg Y, Khalife T, Alomran F, Gaudric J, Chiche L, Koskas F. Excision of a permanent inferior vena cava filter with multiple vena caval perforations. Ann Vasc Surg 2013; 28:261.e7-9. [PMID: 24084266 DOI: 10.1016/j.avsg.2013.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 05/06/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
Perforation of an inferior vena cava filter by one the filter device hooks is a recognized possible complication of this device. We describe a case of surgical excision of a permanent inferior vena cava filter associated with multiple perforations of surrounding structures by each of the 6 hooks of the device. Structures affected include the third lumbar vertebral body, transverse mesocolon, the infrarenal aorta, the duodenum, and the psoas muscle. A thorough understanding of the filter design and adequate preoperative imaging were vital in planning the safe surgical excision of this device.
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Affiliation(s)
- Yannick Georg
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France.
| | - Theresa Khalife
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Faris Alomran
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Julien Gaudric
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Fabien Koskas
- Department of Vascular Surgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France
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Uterine trauma with fetal loss associated with chronic perforation of the inferior vena cava by an infrarenal vena cava filter. J Vasc Surg Venous Lymphat Disord 2013; 1:412-4. [PMID: 26992765 DOI: 10.1016/j.jvsv.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/15/2013] [Accepted: 04/20/2013] [Indexed: 11/21/2022]
Abstract
Gestational complications in pregnant women have been considered a theoretical sequelae of vena cava filters (VCFs) positioned in the infrarenal segment of the inferior vena cava. We describe a 32-year-old woman who became pregnant with the known existence of an asymptomatic but chronically perforated, permanent infrarenal VCF. At 24 weeks gestation, uterine trauma leading to massive intraperitoneal hemorrhage and fetal loss occurred. Our case documents that gestational risk, heretofore theoretical, is real and calls for heightened awareness of the need for appropriate VCF management in women of childbearing age and consideration for preconception evaluation of the filter-bearing inferior vena cava in women considering pregnancy in whom VCFs have been previously implanted.
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Open surgical removal of a tilted and dislodged inferior vena cava filter through a lumbar branch without cavotomy. J Vasc Surg Venous Lymphat Disord 2013; 1:304-8. [DOI: 10.1016/j.jvsv.2012.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
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Harvey J, Hopkins J, McCafferty I, Jones R. Inferior vena cava filters: What radiologists need to know. Clin Radiol 2013; 68:721-32. [DOI: 10.1016/j.crad.2013.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
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Wood EA, Malgor RD, Gasparis AP, Labropoulos N. Reporting the impact of inferior vena cava perforation by filters. Phlebology 2013; 29:471-5. [DOI: 10.1177/0268355513491723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database. Methods We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates. Results Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation ( N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported. Conclusions Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications.
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Affiliation(s)
- Emily A Wood
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Rafael D Malgor
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Antonios P Gasparis
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Olorunsola OG, Kohi MP, Fidelman N, Westphalen AC, Kolli PK, Taylor AG, Gordon RL, LaBerge JM, Kerlan RK. Caval Penetration by Retrievable Inferior Vena Cava Filters: A Retrospective Comparison of Option and Günther Tulip Filters. J Vasc Interv Radiol 2013; 24:566-71. [DOI: 10.1016/j.jvir.2012.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/06/2012] [Accepted: 12/30/2012] [Indexed: 10/27/2022] Open
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Nelson WK, Valentine RJ. Open inferior vena cava filter removal after migration. J Vasc Surg Venous Lymphat Disord 2013; 1:216. [DOI: 10.1016/j.jvsv.2012.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/12/2012] [Accepted: 07/15/2012] [Indexed: 10/27/2022]
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Caldwell EH, Fridley TL, Erb EL, Fleischer SR. Endovascular Retrieval of an Inferior Vena Cava Filter With Simultaneous Caval, Aortic, and Duodenal Perforations. Vasc Endovascular Surg 2012; 46:671-4. [DOI: 10.1177/1538574412465479] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 47-year-old female presented to the emergency department complaining of diffuse abdominal pain and melena. She previously had a Bard G2X inferior vena cava filter placed before undergoing a laparoscopic Roux-en-Y gastric bypass 3 years before her current presentation. She had a history of an anastomotic ulcer that was treated medically. A repeat endoscopic evaluation revealed no evidence of a recent bleed and the ulcer was healed. Computed tomography revealed evidence of multiple filter struts penetrating through the caval wall into the duodenum and aorta. The filter was successfully removed using an En Snare without complications. Reviewing the current literature, open surgical repair has been the treatment of choice for similar patient presentations. We present a successful case of the endovascular retrieval of an inferior vena cava filter with simultaneous caval, aortic, and duodenal penetrations.
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Affiliation(s)
| | - Todd L. Fridley
- Department of Surgery, Kettering Health Network, Dayton, OH, USA
| | - Edward L. Erb
- Department of Vascular Surgery, Kettering Health Network, Dayton, OH, USA
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