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San Valentin EM, Damasco JA, Bernardino M, Court KA, Godin B, Canlas GM, Melancon A, Chintalapani G, Jacobsen MC, Norton W, Layman RR, Fowlkes N, Chen SR, Huang SY, Melancon MP. Image-Guided Deployment and Monitoring of a Novel Tungsten Nanoparticle-Infused Radiopaque Absorbable Inferior Vena Cava Filter in a Swine Model. J Vasc Interv Radiol 2024; 35:113-121.e3. [PMID: 37696432 PMCID: PMC10872373 DOI: 10.1016/j.jvir.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE To improve radiopacity of radiolucent absorbable poly-p-dioxanone (PPDO) inferior vena cava filters (IVCFs) and demostrate their effectiveness in clot-trapping ability. MATERIALS AND METHODS Tungsten nanoparticles (WNPs) were incorporated along with polyhydroxybutyrate (PHB), polycaprolactone (PCL), and polyvinylpyrrolidone (PVP) polymers to increase the surface adsorption of WNPs. The physicochemical and in vitro and in vivo imaging properties of PPDO IVCFs with WNPs with single-polymer PHB (W-P) were compared with those of WNPs with polymer blends consisting of PHB, PCL, and PVP (W-PB). RESULTS In vitro analyses using PPDO sutures showed enhanced radiopacity with either W-P or W-PB coating, without compromising the inherent physicomechanical properties of the PPDO sutures. W-P- and W-PB-coated IVCFs were deployed successfully into the inferior vena cava of pig models with monitoring by fluoroscopy. At the time of deployment, W-PB-coated IVCFs showed a 2-fold increase in radiopacity compared to W-P-coated IVCFs. Longitudinal monitoring of in vivo IVCFs over a 12-week period showed a drastic decrease in radiopacity at Week 3 for both filters. CONCLUSIONS The results highlight the utility of nanoparticles (NPs) and polymers for enhancing radiopacity of medical devices. Different methods of incorporating NPs and polymers can still be explored to improve the effectiveness, safety, and quality of absorbable IVCFs.
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Affiliation(s)
- Erin Marie San Valentin
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jossana A Damasco
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marvin Bernardino
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karem A Court
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Biana Godin
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | | | - Adam Melancon
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Megan C Jacobsen
- Department of Imaging Physics, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Norton
- Department of Veterinary Medicine and Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rick R Layman
- Department of Imaging Physics, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Natalie Fowlkes
- Department of Veterinary Medicine and Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen R Chen
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Y Huang
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marites P Melancon
- Department of Interventional Radiology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
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San Valentin EM, Damasco JA, Bernardino M, Court KA, Godin B, Canlas GM, Melancon A, Chintalapani G, Jacobsen MC, Norton W, Layman RR, Fowlkes N, Chen SR, Huang SY, Melancon MP. Image-guided deployment and monitoring of a novel tungsten nanoparticleâ€"infused radiopaque absorbable inferior vena cava filter in pigs. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.06.527049. [PMID: 36798362 PMCID: PMC9934538 DOI: 10.1101/2023.02.06.527049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The use of absorbable inferior vena cava filters (IVCFs) constructed with poly-p-dioxanone (PPDO) eliminates risks and complications associated with the use of retrievable metallic filters. Radiopacity of radiolucent PPDO IVCFs can be improved with the incorporation of nanoparticles (NPs) made of high-atomic number materials such as gold and bismuth. In this study, we focused on incorporating tungsten NPs (WNPs), along with polyhydroxybutyrate (PHB), polycaprolactone (PCL), and polyvinylpyrrolidone (PVP) polymers to increase the surface adsorption of the WNPs. We compared the imaging properties of WNPs with single-polymer PHB (W-P) and WNPs with polymer blends consisting of PHB, PCL, and PVP (W-PB). Our in vitro analyses using PPDO sutures showed enhanced radiopacity with either W-P or W-PB coating, without compromising the inherent physico-mechanical properties of the PPDO sutures. We observed a more sustained release of WNPs from W-PB-coated sutures than W-P-coated sutures. We successfully deployed W-P- and W-PB-coated IVCFs into the inferior vena cava of pig models, with monitoring by fluoroscopy. At the time of deployment, W-PB-coated IVCFs showed a 2-fold increase in radiopacity compared to W-P-coated IVCFs. Longitudinal monitoring of in vivo IVCFs over a 12-week period showed a drastic decrease in radiopacity at week 3 for both filters. Results of this study highlight the utility of NPs and polymers for enhancing radiopacity of medical devices; however, different methods of incorporating NPs and polymers can still be explored to improve the efficacy, safety, and quality of absorbable IVCFs.
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San Valentin EMD, Barcena AJR, Klusman C, Martin B, Melancon MP. Nano-embedded medical devices and delivery systems in interventional radiology. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1841. [PMID: 35946543 PMCID: PMC9840652 DOI: 10.1002/wnan.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/31/2023]
Abstract
Nanomaterials research has significantly accelerated the development of the field of vascular and interventional radiology. The incorporation of nanoparticles with unique and functional properties into medical devices and delivery systems has paved the way for the creation of novel diagnostic and therapeutic procedures for various clinical disorders. In this review, we discuss the advancements in the field of interventional radiology and the role of nanotechnology in maximizing the benefits and mitigating the disadvantages of interventional radiology theranostic procedures. Several nanomaterials have been studied to improve the efficacy of interventional radiology interventions, reduce the complications associated with medical devices, improve the accuracy and efficiency of drug delivery systems, and develop innovative imaging modalities. Here, we summarize the recent progress in the development of medical devices and delivery systems that link nanotechnology in vascular and interventional radiology. This article is categorized under: Diagnostic Tools > Diagnostic Nanodevices Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease.
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Affiliation(s)
- Erin Marie D San Valentin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
| | | | - Carleigh Klusman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Benjamin Martin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Marites P Melancon
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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He J, Wang Z, Zhou YX, Ni H, Sun X, Xue J, Chen S, Wang S, Niu M. The application of inferior vena cava filters in orthopaedics and current research advances. Front Bioeng Biotechnol 2022; 10:1045220. [PMID: 36479430 PMCID: PMC9719953 DOI: 10.3389/fbioe.2022.1045220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2023] Open
Abstract
Deep vein thrombosis is a common clinical peripheral vascular disease that occurs frequently in orthopaedic patients and may lead to pulmonary embolism (PE) if the thrombus is dislodged. pulmonary embolism can be prevented by placing an inferior vena cava filter (IVCF) to intercept the dislodged thrombus. Thus, IVCFs play an important role in orthopaedics. However, the occurrence of complications after inferior vena cava filter placement, particularly recurrent thromboembolism, makes it necessary to carefully assess the risk-benefit of filter placement. There is no accepted statement as to whether IVCF should be placed in orthopaedic patients. Based on the problems currently displayed in the use of IVCFs, an ideal IVCF is proposed that does not affect the vessel wall and haemodynamics and intercepts thrombi well. The biodegradable filters that currently exist come close to the description of an ideal filter that can reduce the occurrence of various complications. Currently available biodegradable IVCFs consist of various organic polymeric materials. Biodegradable metals have shown good performance in making biodegradable IVCFs. However, among the available experimental studies on degradable filters, there are no experimental studies on filters made of degradable metals. This article reviews the use of IVCFs in orthopaedics, the current status of filters and the progress of research into biodegradable vena cava filters and suggests possible future developments based on the published literature by an electronic search of PubMed and Medline databases for articles related to IVCFs searchable by October 2022 and a manual search for citations to relevant studies.
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Affiliation(s)
| | | | | | - Hongbo Ni
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - XiaoHanu Sun
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Xue
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shanshan Chen
- Institute of Metal Research, Chinese Academy of Sciences (CAS), Shenyang, Liaoning, China
| | - Shuai Wang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meng Niu
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Damasco JA, Huang SY, Perez JVD, Manongdo JAT, Dixon KA, Williams ML, Jacobsen MC, Barbosa R, Canlas GM, Chintalapani G, Melancon AD, Layman RR, Fowlkes NW, Whitley EM, Melancon MP. Bismuth Nanoparticle and Polyhydroxybutyrate Coatings Enhance the Radiopacity of Absorbable Inferior Vena Cava Filters for Fluoroscopy-Guided Placement and Longitudinal Computed Tomography Monitoring in Pigs. ACS Biomater Sci Eng 2022; 8:1676-1685. [PMID: 35343679 PMCID: PMC9045416 DOI: 10.1021/acsbiomaterials.1c01449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inferior vena cava filters (IVCFs) constructed with poly-p-dioxanone (PPDO) are promising alternatives to metallic filters and their associated risks and complications. Incorporating high-Z nanoparticles (NPs) improves PPDO IVCFs' radiopacity without adversely affecting their safety or performance. However, increased radiopacity from these studies are insufficient for filter visualization during fluoroscopy-guided PPDO IVCF deployment. This study focuses on the use of bismuth nanoparticles (BiNPs) as radiopacifiers to render sufficient signal intensity for the fluoroscopy-guided deployment and long-term CT monitoring of PPDO IVCFs. The use of polyhydroxybutyate (PHB) as an additional layer to increase the surface adsorption of NPs resulted in a 2-fold increase in BiNP coating (BiNP-PPDO IVCFs, 3.8%; BiNP-PPDO + PHB IVCFs, 6.2%), enabling complete filter visualization during fluoroscopy-guided IVCF deployment and, 1 week later, clot deployment. The biocompatibility, clot-trapping efficacy, and mechanical strength of the control PPDO (load-at-break, 6.23 ± 0.13 kg), BiNP-PPDO (6.10 ± 0.09 kg), and BiNP-PPDO + PHB (6.15 ± 0.13 kg) IVCFs did not differ significantly over a 12-week monitoring period in pigs. These results indicate that BiNP-PPDO + PHB can increase the radiodensity of a novel absorbable IVCF without compromising device strength. Visualizing the device under conventional radiographic imaging is key to allow safe and effective clinical translation of the device.
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Affiliation(s)
- Jossana A Damasco
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Steven Y Huang
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Joy Vanessa D Perez
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | | | - Katherine A Dixon
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Malea L Williams
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Megan C Jacobsen
- Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Roland Barbosa
- Covalent Metrology Sunnyvale, Sunnyvale, California 94085, United States
| | - Gino Martin Canlas
- Department of Chemistry, Lamar University, Beaumont, Texas 77710, United States
| | | | - Adam D Melancon
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Rick R Layman
- Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Natalie W Fowlkes
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Elizabeth M Whitley
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Marites P Melancon
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
- UT Health Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
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Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism. J Clin Med 2021; 11:jcm11010077. [PMID: 35011826 PMCID: PMC8745208 DOI: 10.3390/jcm11010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). Methods: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. Results: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. Conclusion: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines.
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Eggers MD, Huang SY, Steele JR. When migration is not migration. J Vasc Surg Venous Lymphat Disord 2021; 9:1602-1603. [PMID: 34657675 DOI: 10.1016/j.jvsv.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Steven Y Huang
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph R Steele
- University of Texas MD Anderson Cancer Center, Houston, Texas
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8
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Zheng H, Peng H, Wang P, Li H, Li L, Du Y, Lv G. In vitro and in vivo evaluation of degradability and biocompatibility of poly(p‐dioxanone) hemostatic clips for laparoscopic surgery. J Appl Polym Sci 2021. [DOI: 10.1002/app.50772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Heng Zheng
- College of Physics Sichuan University Chengdu Sichuan China
| | - Haitao Peng
- College of Physics Sichuan University Chengdu Sichuan China
| | - Peng Wang
- Sichuan Guona Technology Company Chengdu Sichuan China
| | - Hong Li
- College of Physics Sichuan University Chengdu Sichuan China
| | - Lin Li
- College of Physics Sichuan University Chengdu Sichuan China
| | - Yan Du
- College of Physics Sichuan University Chengdu Sichuan China
| | - Guoyu Lv
- College of Physics Sichuan University Chengdu Sichuan China
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Góes AMDO, Chaves RHDF, Furlaneto IP, Rodrigues EDM, de Albuquerque FBA, Smit JHA, de Oliveira CP, Abib SDCV. Comparative angiotomographic study of swine vascular anatomy: contributions to research and training models in vascular and endovascular surgery. J Vasc Bras 2021; 20:e20200086. [PMID: 34093675 PMCID: PMC8147709 DOI: 10.1590/1677-5449.200086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Medium and large animal models allow researchers to evaluate the efficacy and safety of cardiovascular procedures in systems that resemble human anatomy and can be used to simulate scenarios for training purposes. Although porcine models have been used extensively, many physiological and anatomical features remain unknown or only superficially described. Objectives To describe the normal porcine vascular anatomy on computed tomography scans, compare it to human vascular anatomy, and discuss the application of porcine models for open and endovascular procedures. Methods Three male Landrace pigs underwent computed tomography. The vascular anatomy of the neck, thorax, abdomen, and limbs was analyzed and described; relevant similarities and differences between porcine and human vascular anatomies and the implications for vascular procedures in pigs are highlighted. Results The carotid territory, aortic arch, and terminal aorta branches all show marked differences in pigs compared to their human counterparts. Compressions of both left renal and common iliac veins were detected, analogous to those seen in human Nutcracker and May-Thurner syndromes. Vascular measurements (diameters, lengths, and angles) of several different porcine territories are presented. Conclusions The data presented should be useful for planning preclinical trials and basic research and for refining surgical training using porcine models in vascular fields.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Centro Universitário do Estado do Pará - CESUPA, Curso de Medicina, Belém, PA, Brasil.,Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Simone de Campos Vieira Abib
- Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
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Role of Inferior Vena Cava Filter Retrieval in Patients on Chronic Anticoagulation Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractPurpose of reviewDescribe the role of inferior vena cava filter (IVCF) retrieval in patients on chronic anticoagulation given the overlap of these treatment options in the management of patients with venous thromboembolic disease.Recent findingsDespite the increase in IVCF retrievals since the Food and Drug Administration safety communications in 2010 and 2014, retrieval rates remain low. Previous studies have shown that longer filter dwell times are associated with greater risk for filter complications and more difficulty with filter retrievals. Recent findings suggest that complications are more frequent in the first 30 days after placement.SummaryThe decision to retrieve an optional IVCF is individualized and requires diligent follow-up with consistent re-evaluation of the need for the indwelling IVCF, particularly in those on long-term anticoagulation therapy.
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11
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Perez JVD, Jacobsen MC, Damasco JA, Melancon A, Huang SY, Layman RR, Melancon MP. Optimization of the differentiation and quantification of high-Z nanoparticles incorporated in medical devices for CT-guided interventions. Med Phys 2020; 48:300-312. [PMID: 33216978 DOI: 10.1002/mp.14601] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Material differentiation has been made possible using dual-energy computed tomography (DECT), in which the unique, energy-dependent attenuating characteristics of materials can provide new diagnostic information. One promising application is the clinical integration of biodegradable polymers as temporary implantable medical devices impregnated with high-atomic number (high-Z) materials. The purpose of this study was to explore the incorporation of high atomic number (high-Z) contrast materials in a bioresorbable inferior vena cava filter for advanced CT-based monitoring of its location and differentiating from surrounding materials. MATERIALS AND METHODS Imaging optimization and calibration studies were performed using a body phantom. The dual-energy CT (DECT) ratios for iron, zirconium, barium, gadolinium, ytterbium, tantalum, tungsten, gold, and bismuth were generated for peak kilovoltage combinations of 80/150Sn, 90/150Sn, and 100/150Sn kVp in dual-source CT via linear regression of the CT numbers at low and high energies. A secondary calibration of the material map to the nominal material concentration was generated to correct for use of materials other than iodine. CT number was calibrated to the material concentration based on single-energy CT (SECT) with additional filtration (150Sn kVp). These quantification methods were applied to monitoring of biodegradable inferior vena cava filters (IVCFs) made of braided poly(p-dioxanone) sutures infused with ultrasmall bismuth nanoparticles (BiNPs) implanted in an adult domestic pig. RESULTS Qualitative material differentiation was optimal for high-Z (>73) contrast agents in DECT. However, quantification became nonlinear and inaccurate as the K-edge of the material increased. Using the high-energy (150Sn kVp) data component as a SECT scan, the linearity of quantification curves was maintained with lower limits of detection than with DECT. Among the materials tested, bismuth had optimal differentiation from iodine in DECT while maintaining increased contrast in high-energy SECT for quantification (11.5% error). Coating the IVCF with BiNPs resulted in markedly greater radiopacity (maximum CT number, 2028 HU) than that of an uncoated IVCF (maximum CT number, 127 HU). Using DECT imaging and processing, the BiNP-IVCF could be clearly differentiated from iodine contrast injected into the inferior vena cava of the pig. CONCLUSIONS These findings may improve widespread integration of medical devices incorporated with high-Z materials into the clinic, where technical success, possible complications, and device integrity can be assessed intraoperatively and postoperatively via DECT imaging.
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Affiliation(s)
- Joy Vanessa D Perez
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jossana A Damasco
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Melancon
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rick R Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marites P Melancon
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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12
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Wong JKL, Tan M, Bakhshayesh P. A review of preclinical absorbable inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2020; 9:510-524.e4. [PMID: 33227458 DOI: 10.1016/j.jvsv.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Absorbable inferior vena cava filters (IVCFs) could be more effective and safer than standard IVCFs in theory, as they will self-resorb over time, thus rendering the need for filter retrieval and the risks associated with it unnecessary. This scoping review aims to evaluate the design of current absorbable IVCFs, review the development phase of the absorbable IVCFs, assess the efficacy of the absorbable IVCFs and their complications, and discuss the limitations and areas for future research. METHODS MEDLINE, PubMed, and Embase databases were electronically searched and citations of relevant studies manually searched. Study selection and data extraction were performed by two independent reviewers using predetermined criteria and stored on premade proforma, respectively. The risk of bias (RoB) for both in vitro and in vivo studies were performed using established RoB tools. RESULTS Eight studies were suitable for inclusion in this scoping review; five were in vivo and three were in vitro studies. No clinical trials were found. The RoB varied from moderate to high for in vivo studies and from low to moderate for in vitro studies. Overall, there was evidence from both in vivo and in vitro studies that absorbable IVCFs were effective in clot capturing and self-resorption and could decrease complications associated with standard IVCFs. However, there was a broad lack of statistical analyses and control groups to determine the significance of these findings. CONCLUSIONS Absorbable IVCFs have shown promising features and results in preclinical models. However, significant research needs to be further performed to achieve the ideal characteristics of an absorbable IVCF before the first human trial can be conducted safely.
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Affiliation(s)
- Joanna K L Wong
- Department of Trauma and Orthopaedics, St Mary's Hospital, London, United Kingdom.
| | - Matthew Tan
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Peyman Bakhshayesh
- Department of Trauma and Orthopaedics, St Mary's Hospital, London, United Kingdom
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13
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Elizondo G, Eggers M, Falcon M, Trevino M, Marrufo R, Perez C, Nunez E, Moreno R, Mitchell A, Sheppard A, Dria S, Jay T, Kirk R, Hovsepian D, Steele J. First-in-Human Study with Eight Patients Using an Absorbable Vena Cava Filter for the Prevention of Pulmonary Embolism. J Vasc Interv Radiol 2020; 31:1817-1824. [PMID: 33008719 DOI: 10.1016/j.jvir.2020.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To prospectively evaluate the initial human experience with an absorbable vena cava filter designed for transient protection from pulmonary embolism (PE). MATERIALS AND METHODS This was a prospective, single-arm, first-in-human study of 8 patients with elevated risk of venous thromboembolism (VTE). Seven absorbable IVC filters (made of polydioxanone that breaks down into H2O and CO2 in 6 mo) were placed prophylactically before orthopedic (n = 5) and gynecologic (n = 2) surgeries, and 1 was placed in a case of deep vein thrombosis. Subjects underwent CT cavography and abdominal radiography before and 5, 11, and 36 weeks after filter placement to assess filter migration, embolization, perforation, and caval thrombosis and/or stenosis. Potential PE was assessed immediately before and 5 weeks after filter placement by pulmonary CT angiography. RESULTS No symptomatic PE was reported throughout the study or detected at the planned 5-week follow-up. No filter migration was detected based on the fixed location of the radiopaque markers (attached to the stent section of the filter) relative to the vertebral bodies. No filter embolization or caval perforation was detected, and no caval stenosis was observed. Throughout the study, no filter-related adverse events were reported. CONCLUSIONS Implantation of an absorbable vena cava filter in a limited number of human subjects resulted in 100% clinical success. One planned deployment was aborted as a result of stenotic pelvic veins, resulting in 89% technical success. No PE or filter-related adverse events were observed.
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Affiliation(s)
- Guillermo Elizondo
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Mitchell Eggers
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584.
| | - Mario Falcon
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Miguel Trevino
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Roberto Marrufo
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Carlos Perez
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Edgar Nunez
- Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Rudy Moreno
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584
| | - Alexis Mitchell
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584
| | - Audrey Sheppard
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584
| | - Stephen Dria
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584
| | - Turner Jay
- Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584
| | - Ray Kirk
- Department of Radiology, Medical Clinic of Houston, Houston, Texas
| | - David Hovsepian
- Department of Radiology, Stanford University, Stanford, California
| | - Joseph Steele
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Huang SY, Damasco JA, Tian L, Lu L, Perez JVD, Dixon KA, Williams ML, Jacobsen MC, Dria SJ, Eggers MD, Melancon AD, Layman RR, Whitley EM, Melancon MP. In vivo performance of gold nanoparticle-loaded absorbable inferior vena cava filters in a swine model. Biomater Sci 2020; 8:3966-3978. [PMID: 32558854 PMCID: PMC7386069 DOI: 10.1039/d0bm00414f] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Absorbable inferior vena cava filters (IVCFs) offer a promising alternative to metallic retrievable filters in providing protection against pulmonary embolism (PE) for patients contraindicated for anticoagulant therapy. However, because absorbable filters are not radiopaque, monitoring of the filter using conventional X-ray imaging modalities (e.g. plain film radiographs, computed tomography [CT] and fluoroscopy) during deployment and follow-up is not possible and represents a potential obstacle to widespread clinical integration of the device. Here, we demonstrate that gold nanoparticles (AuNPs) infused into biodegradable filters made up of poly-p-dioxanone (PPDO) may improve device radiopacity without untoward effects on device efficacy and safety, as assessed in swine models for 12 weeks. The absorbable AuNP-infused filters demonstrated significantly improved visualization using CT without affecting tensile strength, in vitro degradation, in vivo resorption, or thrombus-capturing efficacy, as compared to similar non-AuNPs infused resorbable IVCFs. This study presents a significant advancement to the development of imaging enhancers for absorbable IVCFs.
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Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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15
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Eggers M, Rousselle S, Urtz M, Albright R, Will A, Jourden B, Godshalk C, Dria S, Huang S, Steele J. Randomized Controlled Study of an Absorbable Vena Cava Filter in a Porcine Model. J Vasc Interv Radiol 2019; 30:1487-1494.e4. [PMID: 31202677 DOI: 10.1016/j.jvir.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/07/2019] [Accepted: 04/11/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of an absorbable inferior vena cava (IVC) filter and a benchmark IVC filter in a porcine model. MATERIALS AND METHODS A randomized controlled Good Laboratory Practice study was performed in Domestic Yorkshire cross swine. Sixteen swine were implanted with an absorbable IVC filter (test device; Adient Medical, Pearland, Texas); 8 were implanted with a benchmark metal IVC filter (control device; Cook Medical, Bloomington, Indiana). All animals underwent rotational digital subtraction pulmonary angiography and cavography (anteroposterior and lateral) before filter deployment and 5 and 32 weeks after deployment. Terminal procedures and necropsy were performed at 32 weeks. The IVC, heart, lungs, liver, and kidneys were harvested at necropsy. The reported randomized controlled GLP animal study was conducted at Synchrony Labs, Durham, North Carolina. RESULTS One animal died early in the test cohort of a recurring hemorrhage at the femoral access site resulting from a filter placement complication. All other animals remained clinically healthy throughout the study. No pulmonary embolism was detected at the 5- and 32-week follow-up visits. The absorbable filter subjects experienced less caval wall perforation (0% vs 100%) and thrombosis (0% vs 75%). The control device routinely perforated the IVC and occasionally produced collateral trauma to adjacent tissues (psoas muscle and aorta). The veins implanted with the absorbable filter were macroscopically indistinguishable from normal adjacent veins at 32 weeks except for the presence of radiopaque markers. Nontarget tissues showed no device-related changes. CONCLUSIONS Implantation of the absorbable IVC filter in swine proved safe with no pulmonary emboli detected. There was complete to near-complete resorption of the filter polymer by 32 weeks with restoration of the normal appearance and structure of the IVC.
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Affiliation(s)
- Mitchell Eggers
- Adient Medical, 2315 Delta Bridge Dr, Pearland, TX 77854; University of Texas M.D. Anderson Cancer Center, Houston, Texas.
| | | | - Mark Urtz
- Synchrony Labs, Durham, North Carolina
| | | | | | | | | | - Stephen Dria
- Adient Medical, 2315 Delta Bridge Dr, Pearland, TX 77854
| | - Steven Huang
- University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Joseph Steele
- University of Texas M.D. Anderson Cancer Center, Houston, Texas
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16
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Abstract
Vena cava filters are implantable devices that are placed to trap thrombus originating in the lower extremities and prevent it from migrating to the lungs. In general, inferior vena cava (IVC) filters are indicated for patients who cannot receive anticoagulation. Other indications for IVC filtration are less clear, and guidelines vary. All patients who have a retrievable IVC filter should be followed, and the removal of the IVC filter should be considered once its indication is lost.
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Affiliation(s)
- Brian P Holly
- Vascular and Interventional Radiology, Johns Hopkins Hospital, Interventional Radiology Center, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Brian Funaki
- Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medicine, 5840 South Maryland, MC 2026, Chicago, IL 60637, USA
| | - Mark L Lessne
- Vascular & Interventional Specialists, Charlotte Radiology, 700 East Morehead Street, Charlotte, NC 28202, USA
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17
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Rousselle SD, Ramot Y, Nyska A, Jackson ND. Pathology of Bioabsorbable Implants in Preclinical Studies. Toxicol Pathol 2019; 47:358-378. [DOI: 10.1177/0192623318816681] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Bioabsorbable implants can be advantageous for certain surgical tissue bioengineering applications and implant-assisted tissue repair. They offer the obvious benefits of nonpermanence and eventual restoration of the native tissue’s biomechanical and immunological properties, while providing a structural scaffold for healing and a route for additional therapies (i.e., drug elution). They present unique developmental, imaging, and histopathological challenges in the conduct of preclinical animal studies and in interpretation of pathology data. The bioabsorption process is typically associated with a gradual decline (over months to years) in structural strength and integrity and may also be associated with cellular responses such as phagocytosis that may confound interpretation of efficacy and safety end points. Additionally, as these implants bioabsorb, they become increasingly difficult to isolate histologically and thus imaging modalities such as microCT become very valuable to determine the original location of the implants and to assess the remodeling response in tandem with histopathology. In this article, we will review different types of bioabsorbable implants and commonly used bioabsorbable materials; additionally, we will address some of the most common challenges and pitfalls confronting histologists and pathologists in collecting, handling, imaging, preparing tissues through histology, evaluating, and interpreting study data associated with bioabsorbable implants.
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Affiliation(s)
| | - Yuval Ramot
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
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18
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Dake MD, Murphy TP, Krämer AH, Darcy MD, Sewall LE, Curi MA, Johnson MS, Arena F, Swischuk JL, Ansel GM, Silver MJ, Saddekni S, Brower JS, Mendes R, Dake MD, Feezor R, Kalva S, Kies D, Bosiers M, Ziegler W, Farber M, Paolini D, Spillane R, Jones S, Peeters P. One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter. J Vasc Interv Radiol 2018; 29:1350-1361.e4. [DOI: 10.1016/j.jvir.2018.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/25/2022] Open
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19
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Tian L, Lee P, Singhana B, Chen A, Qiao Y, Lu L, Martinez J, Tasciotti E, Jacobsen MC, Melancon A, McArthur M, Eggers M, Huang S, Melancon MP. In vivo imaging of radiopaque resorbable inferior vena cava filter infused with gold nanoparticles. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10576. [PMID: 31406393 DOI: 10.1117/12.2293738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Radiopaque resorbable inferior vena cava filter (IVCF) were developed to offer a less expensive alternative to assessing filter integrity in preventing pulmonary embolism for the recommended prophylactic period and then simply vanishes without intervention. In this study, we determined the efficacy of gold nanoparticle (AuNP)-infused poly-p-dioxanone (PPDO) as an IVCF in a swine model. Infusion into PPDO loaded 1.14±0.08 % AuNP by weight as determined by elemental analysis. The infusion did not alter PPDO's mechanical strength nor crystallinity (Kruskal-Wallis one-way ANOVA, p<0.05). There was no cytotoxicity observed (one-way ANOVA, p<0.05) when tested against RF24 and MRC5 cells. Gold content in PPDO was maintained at ~2000 ppm during the 6-week incubation in PBS at 37°C. As a proof-of-concept, two pigs were deployed with IVCF, one with AuNP-PPDO and the other without coating. Results show that the stent ring of AuNP-PPDO was highly visible even in the presence of iodine-based contrast agent and after clot introduction, but not of the uncoated IVCF. Autopsy at two weeks post-implantation showed AuNP-PPDO filter was endothelialized onto the IVC wall, and no sign of filter migration was observed. The induced clot was also still trapped within the AuNP-PPDO IVCF. As a conclusion, we successfully fabricated AuNP-infused PPDO IVCF that is radiopaque, has robust mechanical strength, biocompatible, and can be imaged effectively in vivo. This suggests the efficacy of this novel, radiopaque, absorbable IVCF for monitoring its position and integrity over time, thus increasing the safety and efficacy of deep vein thrombosis treatment.
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Affiliation(s)
- Li Tian
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patrick Lee
- College of Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | - Burapol Singhana
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Innovative Nanomedicine Research Unit, Chulabhorn International College of Medicine, Thammasat University, Rangsit Campus, Pathum Thani, Thailand 12120
| | - Aaron Chen
- Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yang Qiao
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Linfeng Lu
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Chemical and Biomolecular Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Jonathan Martinez
- Center for Biomimetic Medicine, Houston Methodist, Houston, TX 77030, USA
| | - Ennio Tasciotti
- Center for Biomimetic Medicine, Houston Methodist, Houston, TX 77030, USA
| | - Megan C Jacobsen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adam Melancon
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark McArthur
- Department of Veterinary Medicine The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Steve Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marites P Melancon
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Graduate School of Biomedical Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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20
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Abstract
The inferior vena cava filter clinical environment is notable for the degree of controversy, uncertainty, and fear associated with these devices by both physicians and the public. This article reviews some of the more important current issues with these devices as well as emerging and future trends.
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21
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Huang SY, Eggers M, McArthur MJ, Dixon KA, McWatters A, Dria S, Hill LR, Melancon MP, Steele JR, Wallace MJ. Safety and Efficacy of an Absorbable Filter in the Inferior Vena Cava to Prevent Pulmonary Embolism in Swine. Radiology 2017; 285:820-829. [PMID: 28708470 DOI: 10.1148/radiol.2017161880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose To evaluate the immediate and long-term safety as well as thrombus-capturing efficacy for 5 weeks after implantation of an absorbable inferior vena cava (IVC) filter in a swine model. Materials and Methods This study was approved by the institutional animal care and use committee. Eleven absorbable IVC filters made from polydioxanone suture were deployed via a catheter in the IVC of 11 swine. Filters remained in situ for 2 weeks (n = 2), 5 weeks (n = 2), 12 weeks (n = 2), 24 weeks (n = 2), and 32 weeks (n = 3). Autologous thrombus was administered from below the filter in seven swine from 0 to 35 days after filter placement. Fluoroscopy and computed tomography follow-up was performed after filter deployment from weeks 1-6 (weekly), weeks 7-20 (biweekly), and weeks 21-32 (monthly). The infrarenal IVC, lungs, heart, liver, kidneys, and spleen were harvested at necropsy. Continuous variables were evaluated with a Student t test. Results There was no evidence of IVC thrombosis, device migration, caval penetration, or pulmonary embolism. Gross pathologic analysis showed gradual device resorption until 32 weeks after deployment. Histologic assessment demonstrated neointimal hyperplasia around the IVC filter within 2 weeks after IVC filter deployment with residual microscopic fragments of polydioxanone suture within the caval wall at 32 weeks. Each iatrogenic-administered thrombus was successfully captured by the filter until resorbed (range, 1-4 weeks). Conclusion An absorbable IVC filter can be safely deployed in swine and resorbs gradually over the 32-week testing period. The device is effective for the prevention of pulmonary embolism for at least 5 weeks after placement in swine. © RSNA, 2017.
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Affiliation(s)
- Steven Y Huang
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Mitchell Eggers
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Mark J McArthur
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Katherine A Dixon
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Amanda McWatters
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Stephen Dria
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Lori R Hill
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Marites P Melancon
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Joseph R Steele
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
| | - Michael J Wallace
- From the Department of Interventional Radiology (S.Y.H., K.A.D., A.M., M.P.M., J.R.S., M.J.W.) and Department of Veterinary Medicine and Surgery (M.J.M., L.R.H.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030; and Adient Medical, Pearland, Tex (M.E., S.D.)
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22
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Steinberger JD, Genshaft SJ. The Role of Inferior Vena Cava Filters in Pulmonary Embolism. Tech Vasc Interv Radiol 2017; 20:197-205. [PMID: 29029715 DOI: 10.1053/j.tvir.2017.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary embolism (PE) is a cause of significant morbidity and mortality, with an estimated 600,000 cases of clinically significant PE in the United States annually, and roughly 200,000 deaths per annum directly attributable to PE. By far the most frequent cause of PE is deep vein thrombosis originating in the lower extremities, which travels to the pulmonary vasculature. The mainstay of treatment is anticoagulation, but multiple additional treatments exist for patients in whom anticoagulation is inadequate or contraindicated. The absolute indications for inferior vena cava (IVC) filtration are narrow, but many filters are placed in patients with relative indications. There is growing concern for overuse of IVC filters, with a relatively low rate of retrieval. It is essential for interventional radiologists to understand the appropriate and correct use and retrieval of IVC filters. Familiarity with placement techniques, protocols and techniques for retrieval, current and emerging technologies, and the clinical model for management of venous thromboembolism, will ensure that interventional radiologists remain an integral member of the care team for these often complex patients.
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Affiliation(s)
| | - Scott J Genshaft
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
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23
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Dria SJ, Eggers MD. In vitro evaluation of clot capture efficiency of an absorbable vena cava filter. J Vasc Surg Venous Lymphat Disord 2016; 4:472-8. [PMID: 27639002 DOI: 10.1016/j.jvsv.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the in vitro clot capture efficiency (CCE) of an investigational absorbable inferior vena cava filter (IVCF) vs the Greenfield IVCF. METHODS Investigational absorbable and Greenfield filters were challenged with polyacrylamide clot surrogates ranging from 3 × 5 to 10 × 24 mm (diameter × length) in a flow loop simulating the venous system. Filters were challenged with clots until CCE standard error of 5% or less was achieved under binomial statistics. Pressure gradients across the filters were measured for the largest size clot, enabling calculation of forces on the filter. RESULTS The in vitro CCE of the absorbable IVCF was statistically similar to that of the Greenfield filter for all clot sizes apart from the 3 × 10-mm clot, for which there was statistically significant difference between filter CCEs (absorbable filter, 59%; Greenfield filter, 31%; P = .0001). CCE ranged from an average 32% for the 3 × 5-mm clot to 100% for 7 × 10-mm and larger clots for the absorbable IVCF. Pressure gradient across the absorbable filter with 10 × 24-mm clot averaged 0.14 mm Hg, corresponding to a net force on the filter of 2.1 × 10(-3) N, compared with 0.39 mm Hg or 5.8 × 10(-3) N (P < .001) for the Greenfield filter. CONCLUSIONS CCE of the absorbable filter was statistically similar to or an improvement on that of the Greenfield stainless steel filter for all clot sizes tested. CCE of the Greenfield filter in this study aligned with data from previous studies. Given the efficacy of the Greenfield filter in attenuating the risk of pulmonary embolism, the current study suggests that the absorbable filter may be a viable candidate for subsequent human testing.
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Affiliation(s)
| | - Mitchell D Eggers
- Adient Medical, Pearland, Tex; Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex; Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
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