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Kurzyna P, Banaszkiewicz M, Florczyk M, Kępski J, Piłka M, Kędzierski P, Mańczak R, Szwed P, Kasperowicz K, Wrona K, Doroszewski G, Torbicki A, Kurzyna M, Szmit S, Darocha S. Safety and Outcomes of Inferior Vena Cava Filter Placement in Oncology Patients: A Single-Centre Experience. Cancers (Basel) 2024; 16:1562. [PMID: 38672644 PMCID: PMC11049443 DOI: 10.3390/cancers16081562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The risk of venous thromboembolism (VTE) in the oncology population is significantly higher than in non-cancer patients. Inferior vena cava (IVC) filters may, therefore, be an important part of VTE treatment. In this study, we address the outcomes of placing IVC filters in the oncology population. This single-centre, observational, retrospective study included 62 patients with active malignancy and acute VTE who underwent an IVC filter implantation due to contraindications to anticoagulation during the period 2012-2023. The control group consisted of 117 trauma patients. In both groups, an urgent surgical procedure requiring temporary cessation of anticoagulation was the most noted reason for IVC filter placement-76% in the oncology group vs. 100% in the non-oncology group (p < 0.001). No complications were reported during the IVC filter implantation procedures. There was no recurrence of pulmonary embolism or deep venous thrombosis in the oncology group after filter implantation. The rate of successful filter explantation, median time to retrieval, and abnormal findings during retrieval were not significantly different between both subgroups (64.3% vs. 76.5%, p = 0.334; 77 days vs. 84 days, p = 0.764; 61.5% vs. 54.2%, p = 0.672; respectively). The study showed that IVC filter placement is a safe and effective method of preventing PE in cancer patients with contraindications to anticoagulation. The complication rate following IVC filter implantation in cancer patients is low and similar to that in non-oncology patients.
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Affiliation(s)
- Paweł Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Jarosław Kępski
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Szwed
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Krzysztof Kasperowicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Katarzyna Wrona
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Grzegorz Doroszewski
- Centre of Postgraduate Medical Education, Pelvic Injury and Pathology Department, Konarskiego 13, 05-400 Otwock, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Sebastian Szmit
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
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Juarez JJ, Khalid MU, Ulloa BA, Romero CM, Maruthi R, Shah D, Chang E, Shafi I, Lakhter V, Zhao H, Rodriquez EJ, Pérez-Stable EJ, Bashir R. Racial and ethnic disparities in inferior vena cava filter placement for deep vein thrombosis in the United States. J Vasc Surg Venous Lymphat Disord 2024; 12:101683. [PMID: 37708935 DOI: 10.1016/j.jvsv.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We sought to determine whether racial and ethnic disparities existed in inferior vena cava (IVC) filter (IVCF) placement rates among Black and Latino patients for the treatment of acute proximal lower extremity (LE) deep vein thrombosis (DVT) in the United States from 2016 to 2019. METHODS We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal LE DVT from January 2016 to December 2019, including self-reported patient race and ethnicity. IVCF placement rates were identified using International Classification of Diseases, 10th revision, codes. Weighted multivariable logistic regression was used to compare IVCF use by race and ethnicity. The regression model was adjusted for patient demographics (ie, sex, primary payer, quartile classification of household income), hospital information (ie, region, location, teaching status, bed size), weekend admission, and clinical characteristics (ie, modified Charlson comorbidity index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, contraindications to anticoagulation, including other major bleeding). RESULTS Of 134,499 acute proximal LE DVT patients, 18,909 (14.1%) received an IVCF. Of the patients who received an IVCF, 12,733 were White (67.3%), 3563 were Black (18.8%), and 1679 were Latino (8.9%). IVCF placement decreased for all patient groups between 2016 and 2019. After adjusting for the U.S. population distribution, the IVCF placement rates were 11 to 12/100,000 persons for Black patients, 7 to 8/100,000 persons for White patients, and 4 to 5/100,000 persons for Latino patients. The difference in IVCF placement rates was statistically significant between patient groups (Black patients vs White patients, P < .05; Black patients vs Latino patients, P < .05; Latino patients vs White patients, P < .05). CONCLUSIONS This nationwide study showed that Black patients have higher IVCF placement rates compared with White and Latino patients. Given the known long-term complications and uncertain benefits of IVCFs, coupled with the 2010 U.S. Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias might be perpetuating this disparity.
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Affiliation(s)
- Jordan J Juarez
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Muhammad U Khalid
- Department of Vascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bianca A Ulloa
- Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, NY
| | - Carlos M Romero
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Rohit Maruthi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Devrat Shah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Eric Chang
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Irfan Shafi
- Division of Cardiovascular Medicine, Wayne State University, Detroit Medical Center, Detroit, MI
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Riyaz Bashir
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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Shahid MU, Nirgudkar N, Chandra V, Gonzales S, Kumar A. Influence of Exercise on Inferior Vena Cava Wall Interaction with Inferior Vena Cava Filters: Results of a Pilot In Vivo Porcine Study. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1757782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Purpose The aim of this study was to assess the effect of mild exercise on inferior vena cava (IVC) filter interaction with imaging and pathological features with the neighboring vessel wall utilizing a porcine model.
Methods After Institutional Animal Care and Use Committee (IACUC) approval, retrievable Option Elite IVC filters were implanted in six Yorkshire pigs utilizing the right common femoral vein approach under general anesthesia. Group A (n = 4) pigs remained sedentary for 4 weeks. Group B (n = 2) pigs were exercised using a harness and treadmill for 10 minutes/day for 4 days/week. At approximately 4 weeks, IVC venograms were performed and the pigs were sacrificed. After laparotomy, the IVC was ligated above and below the filter, excised and fixed in formalin. Gross and histological examination of the IVC was performed. Gross images of each sample were captured before removal of the filters. One longitudinal, one tangential, and five transverse representative sections were processed for paraffin sectioning and hematoxylin and eosin slides were prepared. A pathologist examined all tissues to assess differences between normal vein, group A and group B pigs. The pathologist provided an overall assessment and representative images.
Results All IVC filter implantations were technically successful without adverse effects. There was no incidence of caval thrombosis, filter strut fracture, or filter migration in either group. On gross pathological examination, IVC of the pigs in group B demonstrated more perivascular and mural fibrosis than those pigs in group A. Histopathological findings correlated with gross findings.
Conclusions In this pilot study, there were no incidence of IVC filter strut fracture, penetration or IVC occlusion in sedentary or exercised pigs. However, there tended to be more perivascular and mural fibrosis on pathological examination of inferior vena cavas from exercised pigs. Further larger scale studies may employ the porcine model to further understand the role exercise may play on IVC filter and caval wall interaction.
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Affiliation(s)
- M. Usman Shahid
- Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Neel Nirgudkar
- Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Vishnu Chandra
- Department of Radiology, University of Virginia Medical School, Charlottesville, Virginia, United States
| | - Sharon Gonzales
- Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Abhishek Kumar
- Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, United States
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Clinical Practice and Volume Trends of Inferior Vena Cava Filter Utilization at a Single Tertiary Care Center over a 19 Year Period. J Vasc Surg Venous Lymphat Disord 2022; 10:887-893. [DOI: 10.1016/j.jvsv.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
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Han K, Kim MD, Kim GM, Kwon JH, Lee J, Won JY, Moon S, An H. Comparison of Retrievability and Indwelling Complications of Celect and Denali Infrarenal Vena Cava Filters: A Randomized, Controlled Trial. Cardiovasc Intervent Radiol 2021; 44:1536-1542. [PMID: 34312689 DOI: 10.1007/s00270-021-02928-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the Celect and Denali filters in terms of complex filter retrieval and indwelling complications after a 2-month indwelling time. MATERIALS AND METHODS In this prospective, randomized trial, 153 subjects were assessed for eligibility between May 2016 and July 2018. A total of 136 participants were randomly assigned to receive either Celect (n = 68) or Denali (n = 68) filter placement in the infrarenal inferior vena cava. Tilt angles at placement and retrieval and rates of overall filter retrieval, indwelling complication, and complex retrieval were compared. RESULTS Of 136 participants (mean age, 62 ± 12.8 years, 55 male), 24 (17.6%) were lost to follow-up. The mean indwelling time of filter was 60.4 ± 7 days and there was no significant difference in the baseline characteristics between the two groups. Filter retrieval was successful in all participants (112/112, 100%). Significantly higher rates of filter tilt > 15° (n = 8) and strut penetration (n = 14) were found with the Celect filter than with the Denali filter (1 significant tilt and 1 penetration) (P = 0.033 and 0.001, respectively). No filter fractures were observed and there was no significant difference in tip embedment, filter fracture, filter migration, or mean fluoroscopy times. There were 3 cases of complex retrieval (1 for Denali vs. 2 for Celect, P = 0.500), for which the loop-snare technique was used. CONCLUSION Denali filters demonstrated significantly lower rates of tilt angle > 15° and strut penetration. However, there was no significant difference in the complex filter retrieval rate between the Celect and Denali filters.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sungmo Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Hyeongsu An
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
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Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population. Int J Vasc Med 2020; 2020:6582742. [PMID: 32089887 PMCID: PMC7025073 DOI: 10.1155/2020/6582742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/ Methods A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.
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Rockson HB, DiPaola CP, Connolly PJ, Stauff MP. Venous Thromboembolism Prophylaxis for Patients Having Elective Spine Surgery: When, Why, and How Much. J Bone Joint Surg Am 2019; 101:1220-1229. [PMID: 31274725 DOI: 10.2106/jbjs.18.00849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hayden B Rockson
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Christian P DiPaola
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Patrick J Connolly
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Michael P Stauff
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
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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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Retrievable Inferior Vena Cava Filters: A Tertiary Centre Perspective and Quality Assurance Study. Can Assoc Radiol J 2019; 70:193-198. [DOI: 10.1016/j.carj.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/04/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To conduct a retrospective review and quality assurance study of inferior vena cava (IVC) filter retrieval over a two-year period at a tertiary care centre. Methods Patients who underwent IVC filter placement or retrieval over a two-year period were identified. Medical records were reviewed for patient characteristics, filter indication, time to filter retrieval, and complications. Results IVC filters were placed in 229 patients between January 1, 2015 and December 31, 2016. 113 retrievals were attempted and 101 filters were successfully retrieved (89.4%). Median time to first retrieval attempt was 48 days (range of 5–728). Seventy-one patients died in the interval after filter insertion before a retrieval attempt at a median time of 27 days (range of 3–430). In 17 patients, retrieval was complicated by or delayed because of penetration of IVC wall (n = 6), large thrombus burden trapped by filter (n = 5), filter tilt or migration (n = 3), and unclear reasons (n = 3). Time-to-first unsuccessful retrieval attempt was 141 days (median). Of all filters placed, 55.9% were never retrieved. Excluding deceased patients with in-situ filters (n = 71) and unsuccessful retrievals left in-situ as permanent filters (n = 5), there remains 52 patients (33%), with a median filter in-situ time of 488 days. Conclusion Our study indicates that as many as 33% of patients may have been lost to follow-up of their in-situ IVC filter. Considering widespread reports of long-term complications and the recent safety alert issued by Health Canada, it is evident that a unified strategy is needed to track patients post filter insertion.
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Crumley KD, Hyatt E, Kalva SP, Shah H. Factors Affecting Inferior Vena Cava Filter Retrieval: A Review. Vasc Endovascular Surg 2018; 53:224-229. [DOI: 10.1177/1538574418814061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Over the last 2 decades, there has been an exponential rise in placement of retrievable inferior vena cava (IVC) filters, while the retrieval rate has remained steadily low. Approaches to increasing filter retrieval rates have been extensively studied. Conclusion: This review presents an up-to-date review of reported data-driven variables that affect retrieval rates of IVC filters, with a focus on clinical, technical, and process factors.
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Affiliation(s)
- Kristen D. Crumley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eddie Hyatt
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P. Kalva
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hriday Shah
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cook AD, Gross BW, Osler TM, Rittenhouse KJ, Bradburn EH, Shackford SR, Rogers FB. Vena Cava Filter Use in Trauma and Rates of Pulmonary Embolism, 2003-2015. JAMA Surg 2017; 152:724-732. [PMID: 28492861 DOI: 10.1001/jamasurg.2017.1018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vena cava filter (VCF) placement for pulmonary embolism (PE) prophylaxis in trauma is controversial. Limited research exists detailing trends in VCF use and occurrence of PE over time. Objective To analyze state and nationwide temporal trends in VCF placement and PE occurrence from 2003 to 2015 using available data sets. Design, Setting, and Participants A retrospective trauma cohort study was conducted using data from the Pennsylvania Trauma Outcome Study (PTOS) (461 974 patients from 2003 to 2015), the National Trauma Data Bank (NTDB) (5 755 095 patients from 2003 to 2014), and the National (Nationwide) Inpatient Sample (NIS) (24 449 476 patients from 2003 to 2013) databases. Main Outcomes and Measures Temporal trends in VCF placement and PE rates, filter type (prophylactic or therapeutic), and established predictors of PE (obesity, pregnancy, cancer, deep vein thrombosis, major procedure, spinal cord paralysis, venous injury, lower extremity fracture, pelvic fracture, central line, intracranial hemorrhage, and blood transfusion). Prophylactic filters were defined as VCFs placed before or without an existing PE, while therapeutic filters were defined as VCFs placed after a PE. Results Of the 461 974 patients in PTOS, the mean (SD) age was 47.2 (26.4) and 61.6% (284 621) were men; of the 5 755 095 patients in NTDB, the mean age (SD) was 42.0 (24.3) and 63.7% (3 666 504) were men; and of the 24 449 476 patients in NIS, the mean (SD) age was 58.0 (25.2) and 49.7% (12 160 231) were men. Of patients receiving a filter (11 405 in the PTOS, 71 029 in the NTDB, and 189 957 in the NIS), most were prophylactic VCFs (93.6% in the PTOS, 93.5% in the NTDB, and 93.3% in the NIS). Unadjusted and adjusted temporal trends for the PTOS and NTDB showed initial increases in filter placement followed by significant declines (unadjusted reductions in VCF placement rates, 76.8% in the PTOS and 53.3% in the NTDB). The NIS demonstrated a similar unadjusted trend, with a slight increase and modest decline (22.2%) in VCF placement rates over time; however, adjusted trends showed a slight but significant increase in filter rates. Adjusted PE rates for the PTOS and NTDB showed significant initial increases followed by slight decreases, with limited variation during the declining filter use periods. The NIS showed an initial increase in PE rates followed by a period of stagnation. Conclusions and Relevance Despite a precipitous decline of VCF use in trauma, PE rates remained unchanged during this period. Taking this association into consideration, VCFs may have limited utility in influencing rates of PE. More judicious identification of at-risk patients is warranted to determine individuals who would most benefit from a VCF.
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Affiliation(s)
- Alan D Cook
- Trauma Research Program, Chandler Regional Medical Center, Chandler, Arizona
| | - Brian W Gross
- Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Turner M Osler
- Department of Surgery, University of Vermont College of Medicine, Burlington
| | | | - Eric H Bradburn
- Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | | | - Frederick B Rogers
- Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
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Kang J, Ko HK, Shin JH, Ko GY, Jo KW, Huh JW, Oh YM, Lee SD, Lee JS. Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism. Vasc Med 2017; 22:512-517. [PMID: 28879803 DOI: 10.1177/1358863x17726596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.
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Affiliation(s)
- Jieun Kang
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heung-Kyu Ko
- 2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- 2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Young Ko
- 2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Wook Jo
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Won Huh
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Do Lee
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Lee
- 1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,3 Department of Pulmonary and Critical Care Medicine, Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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13
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Indications, complications and outcomes of inferior vena cava filters: A retrospective study. Thromb Res 2017; 153:123-128. [DOI: 10.1016/j.thromres.2017.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/20/2017] [Accepted: 02/14/2017] [Indexed: 11/21/2022]
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Ryan E, Kok HK, Lee MJ. Retrievable IVC filters - Friend or foe. Surgeon 2016; 15:104-108. [PMID: 27520332 DOI: 10.1016/j.surge.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 01/09/2023]
Abstract
Venous thromboembolism is a common condition with widely varied outcomes. Pulmonary embolism is associated with a case-fatality rate of up to 8%, increasing up to 18-fold in massive PE. Pharmacological treatment of VTE with anticoagulant medication (AC) is the first line therapy of choice. Retrievable inferior vena cava filters (IVCF) are indicated as a short-term replacement for AC in certain circumstances. Most of the evidence concerning IVCF pertains to permanent filters and older filter models. Limited evidence for retrievable IVCF results in poor consensus regarding indications, follow-up and retrieval. Complications increase with dwell-time and retrieval success rates decline. Professional bodies advocate strict guideline adherence and robust strategies for filter monitoring to maximise retrieval rate.
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Affiliation(s)
- E Ryan
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland
| | - H K Kok
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland
| | - M J Lee
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland.
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Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior Vena Cava Thrombosis. JACC Cardiovasc Interv 2016; 9:629-43. [PMID: 26952909 DOI: 10.1016/j.jcin.2015.12.268] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/22/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter. Due to the substantial increase in the number of IVC filters placed in the United States and the very low filter retrieval rates, clinicians are faced with a very large population of patients at risk for developing IVC thrombosis. Nevertheless, there is a paucity of data and societal guidelines with regards to the diagnosis and management of IVC thrombosis. This paper aims to enhance the awareness of this uncommon, but morbid, condition by providing a concise, yet comprehensive, review of the etiology, diagnostic approaches, and treatment strategies in patients with IVC thrombosis.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
| | - Mohammad Morad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Craig R Narins
- Division of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York; Department of Surgery, Section of Vascular Surgery, University of Rochester Medical Center, Rochester, New York
| | - Farhan Raza
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, Pennsylvania
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, Pennsylvania
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Tan WP, Sherer BA, Khare N. Unfriendly Filter: An Unusual Cause of Hydronephrosis and Hematuria. Urology 2016; 87:e9-e10. [DOI: 10.1016/j.urology.2015.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/10/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022]
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Blevins EM, Glanz K, Huang YSV, Raffini L, Shinohara RT, Witmer C. A Multicenter Cohort Study of Inferior Vena Cava Filter Use in Children. Pediatr Blood Cancer 2015. [PMID: 26206486 DOI: 10.1002/pbc.25662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To describe inferior vena cava (IVC) filter use in pediatric patients admitted to U.S. children's hospitals and to determine factors associated with prophylactic placement. PROCEDURE This retrospective multicenter cohort study utilized data from the Pediatric Health Information Systems (PHIS) administrative database, with 44 participating children's hospitals. Subjects included for analysis were less than 21 years of age, admitted to a PHIS hospital between January 1, 2004 and December 31, 2012 and had a procedure code for IVC filter placement. ICD-9-CM discharge codes were used to identify subjects with a venous thromboembolism (VTE). Pharmaceutical billing codes were used to identify anticoagulation use. RESULTS During this 9-year-study period, 276 subjects met the inclusion criteria. The median age of subjects was 15 years (range 1 month-20 years). Subjects had an ICD-9-CM code for VTE 76% of the time and were started on anticoagulation after IVC filter placement 77% of the time. The mean number of IVC filters placed per year was 6 per 100,000 admissions (SD-1.4), which was constant throughout the study period (P = 0.12). The median number of filters placed by center was 4.5 (range 0-32). In multivariate analysis, subjects undergoing orthopedic surgery were more likely to have prophylactic placement of an IVC filter (OR 4.5; 95%CI 1.8-11). CONCLUSIONS IVC filter placement in pediatric patients remains a rare event and is most common in adolescents. Unlike in adults, pediatric IVC filter placement does not appear to be increasing over time and is predominantly used in the setting of a venous thrombotic event.
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Affiliation(s)
- Erin M Blevins
- Department of Pediatrics, Hematology and Oncology, Naval Medical Center San Diego, California
| | - Karen Glanz
- Divisions of Epidemiology and Nursing, Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yuan-Shung V Huang
- Department of Pediatrics, Healthcare Analytics Unit, Children's Hospital of Philadelphia, Pennsylvania
| | - Leslie Raffini
- Divisions of Hematology, Departments of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Char Witmer
- Divisions of Hematology, Departments of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Liu D, Peterson E, Dooner J, Baerlocher M, Zypchen L, Gagnon J, Delorme M, Sing CK, Wong J, Guzman R, Greenfield G, Moodley O, Yenson P. Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. CMAJ 2015; 187:1288-1296. [PMID: 26416989 PMCID: PMC4646749 DOI: 10.1503/cmaj.141614] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- David Liu
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask.
| | - Erica Peterson
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - James Dooner
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Mark Baerlocher
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Leslie Zypchen
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Joel Gagnon
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Michael Delorme
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Chad Kim Sing
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Jason Wong
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Randolph Guzman
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Gavin Greenfield
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Otto Moodley
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
| | - Paul Yenson
- Department of Radiology (Liu), Division of Hematology, Department of Medicine (Peterson, Zypchen, Yenson), Department of Vascular Surgery (Gagnon), Vancouver General Hospital, Vancouver, BC; Vascular Surgery Victoria (Dooner), Victoria General Hospital, Victoria, BC; Department of Interventional Radiology (Baerlocher), University of Toronto, Toronto, Ont.; Department of Hematology (Delorme), Kelowna General Hospital, Kelowna, BC; Departments of Emergency Medicine (Kim Sing) and Radiology (Wong), Foothills Medical Centre, Calgary, Alta.; Department of Vascular Surgery (Guzman), St. Boniface Hospital, Winnipeg, Man.; Department of Emergency Medicine (Greenfield), University of Calgary, Calgary, Alta.; Department of Hematology (Moodley), Royal University Hospital, Saskatoon, Sask
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Eggers MD, McArthur MJ, Figueira TA, Abdelsalam ME, Dixon KP, Pageon LR, Wallace MJ, Huang SY. Pilot in vivo study of an absorbable polydioxanone vena cava filter. J Vasc Surg Venous Lymphat Disord 2015; 3:409-420. [PMID: 26992619 DOI: 10.1016/j.jvsv.2015.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objectives of this study were to evaluate tensile strength retention of polydioxanone as a function of time in a swine venous system and to assess the feasibility of an absorbable inferior vena cava (IVC) filter made from polydioxanone in a pilot swine study. METHODS Twenty strands (60 cm each) of size 1 polydioxanone absorbable suture (Ethicon, Somerville, NJ) were placed in the central venous system of domestic swine. Strands were harvested at weekly intervals during 10 weeks for tensile strength testing. Results were compared with control samples obtained from an in vitro engineered circulation system containing sodium phosphate buffer solution. Three IVC filters braided from polydioxanone suture were also catheter deployed in three swine to assess absorbable IVC filter feasibility. RESULTS Polydioxanone retained 82% tensile strength in vitro vs 79% in vivo at 35 days (P > .22), the desired prophylactic duration. For IVC filters made from polydioxanone, technical success of placement was achieved in all three filters deployed (100%). Autologous thrombus deployed inferior to the filter remained trapped in the filter until thrombus resorption, with no evidence of pulmonary emboli on follow-up computed tomography. There were no instances of caval penetration, filter-induced IVC thrombosis, filter migration, or tilt >15 degrees with imaging and clinical follow-up carried out to 32 weeks. CONCLUSIONS Strength retention of polydioxanone suture placed in the venous system of swine is similar to earlier in vitro studies out to 10 weeks (P > .06 for all weeks) and is more than sufficient (8.20 ± 0.37 kg mean load at break for size 1) to trap thrombus. Pilot animal study suggests that an absorbable polydioxanone IVC filter can be catheter deployed to capture and to hold iatrogenically administered autologous thrombus through resorption.
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Affiliation(s)
- Mitchell D Eggers
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex.
| | - Mark J McArthur
- Department of Veterinary Medicine and Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Tomas A Figueira
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Katherine P Dixon
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Laura R Pageon
- Department of Veterinary Medicine and Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Michael J Wallace
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Steven Y Huang
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex
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Inferior vena cava filters in patients with advanced-stage cancer. Hematol Oncol Stem Cell Ther 2014; 7:136-41. [PMID: 25300564 DOI: 10.1016/j.hemonc.2014.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE). Inferior vena cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation. PATIENTS AND METHODS A retrospective analysis of 107 cancer patients who had IVC filters inserted and followed up at our institution was performed. All patients had active cancer; a majority (> 90%) had advanced-stage disease, whereas only five patients (5.8%) had stages I or II disease. RESULTS Eighty six patients (80.3%) had their IVC filter placed through a jugular approach. Filter insertion was not without complications; recurrent deep vein thrombosis (DVT) was reported in 10 (9.3%), PE in three (2.8%) and filter thrombosis in one patient. The value of IVC filter in patients with advanced stage disease was very limited: among 59 patients with stage IV disease for whom survival data was available, the median survival was only 1.31 months (0.92-2.20) with 23 patients (39.0%) surviving less than a month, and 40 (67.8%) surviving less than three months. CONCLUSIONS Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or PE is high, IVC filters can be utilized. However, the placement of such filters should take into consideration the stage of disease and life expectancy of such patients. Patients with advanced-stage disease may gain little benefit from IVC filter insertion.
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Alkhouli M, Bashir R. Inferior vena cava filters in the United States: less is more. Int J Cardiol 2014; 177:742-3. [PMID: 25131922 DOI: 10.1016/j.ijcard.2014.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/02/2014] [Indexed: 11/26/2022]
Abstract
Despite the widespread use of Inferior vena cava (IVC) filters, there is no quality evidence to demonstrate their efficacy for routine use, nor there is a consensus on their appropriate indications among major medical societies. The introduction of retrievable filters led to further increase in the utilization of these devices. However, several studies have shown that retrievable filters are rarely retrieved. The implant rates of IVC filters are many folds higher in the United States than in Europe, yet the retrieval rates are much lower. The U.S. Food and Drug Administration has recently issued a safety alert advocating for consideration of filter retrieval when the protection offered by the filter is no longer needed. The controversies surrounding IVC filter placement and retrieval, however, will likely to continue in the absence of good evidence on their efficacy and side effects. Time has come for initiatives to conduct well designed trials based on agreed-upon criteria to settle this debate.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiovascular Medicine, Temple University School of Medicine, Philadelphia, PA, United States.
| | - Riyaz Bashir
- Division of Cardiovascular Medicine, Temple University School of Medicine, Philadelphia, PA, United States
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Peterson EA, Yenson PR, Liu D, Lee AY. Predictors of attempted inferior vena cava filters retrieval in a tertiary care centre. Thromb Res 2014; 134:300-4. [DOI: 10.1016/j.thromres.2014.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 11/28/2022]
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Agos A, Kanellos P, Petty K, Kharasch M, Wang E. Vena caval thrombosis after trauma to the liver. TRAUMA-ENGLAND 2014. [DOI: 10.1177/1460408613507689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thrombosis of the inferior vena cava due to compression of the inferior vena cava by a hepatic haematoma is seemingly rare. We present a case of a 56-year-old female with a hepatic haematoma after blunt trauma that caused this type of compression. The constriction resulted in the formation of an inferior vena cava thrombus, and considering the contraindication to anticoagulation, we placed a retrievable inferior vena cava filter under standard fluoroscopy. This case stresses the need for systematic investigation of the abdomen, especially after a blunt trauma, which can cause compression of the inferior vena cava. Furthermore, inferior vena cava thrombosis should be considered in patients with compression of the inferior vena cava due to hepatic haematoma.
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Avgerinos E, Bath J, Stevens J, McDaniel B, Marone L, Dillavou E, Cho J, Makaroun M, Chaer R. Technical and Patient-related Characteristics Associated with Challenging Retrieval of Inferior Vena Cava Filters. Eur J Vasc Endovasc Surg 2013; 46:353-9. [DOI: 10.1016/j.ejvs.2013.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
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25
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Dixon A, Stavropoulos SW. Improving retrieval rates for retrievable inferior vena cava filters. Expert Rev Med Devices 2013; 10:135-41. [PMID: 23278230 DOI: 10.1586/erd.12.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The introduction of retrievable inferior vena cava (IVC) filters was an important step in the evolution of deep vein thrombosis/pulmonary embolism management. Their removability makes them preferred to permanent filters in many cases. IVC filter retrieval often occurs at a suboptimal rate, leading to complications associated with long-term placement. Improving retrievability includes solutions for patients being lost to follow-up, filter malpositioning, need arising for permanent IVC filtration, filtration requiring longer than the filter's window of retrievability, and filter compromise by the presence of a large trapped clot. This review explores these strategies for retrieval in detail in hopes of improving IVC filter retrieval rates.
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Affiliation(s)
- Austin Dixon
- University of Pennsylvania Health System, 3600 Chestnut Street, Philadelphia, PA 19104, USA.
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Tan XL, Tam C, Mckellar R, Nandurkar H, Bazargan A. Out of sight, out of mind: an audit of inferior vena cava filter insertion and clinical follow up in an Australian institution and literature review. Intern Med J 2013; 43:365-72. [DOI: 10.1111/j.1445-5994.2012.02869.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/23/2012] [Indexed: 11/26/2022]
Affiliation(s)
- X. L. Tan
- Department of Haematology; St Vincent's Hospital; Melbourne; Victoria; Australia
| | - C. Tam
- Department of Haematology; St Vincent's Hospital; Melbourne; Victoria; Australia
| | - R. Mckellar
- Department of Radiology; St Vincent's Hospital; Melbourne; Victoria; Australia
| | - H. Nandurkar
- Department of Haematology; St Vincent's Hospital; Melbourne; Victoria; Australia
| | - A. Bazargan
- Department of Haematology; St Vincent's Hospital; Melbourne; Victoria; Australia
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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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28
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Uberoi R, Tapping CR, Chalmers N, Allgar V. British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry. Cardiovasc Intervent Radiol 2013; 36:1548-1561. [DOI: 10.1007/s00270-013-0606-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 01/19/2013] [Indexed: 11/24/2022]
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Antonoff MB, Beilman GJ. Inferior vena cava clip migration: unusual cause of duodenal foreign body. Ann Vasc Surg 2012; 26:1129.e5-8. [PMID: 22981011 DOI: 10.1016/j.avsg.2012.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/23/2012] [Accepted: 04/02/2012] [Indexed: 12/28/2022]
Abstract
Before the development of the inferior vena cava (IVC) filter, various techniques of IVC interruption were described for the management of patients at high risk for thromboembolic events, and for whom anticoagulation was either inadequate or contraindicated. In this report, we describe the enteric migration of a Miles IVC clip, occurring 27 years after IVC interruption. This previously undescribed complication and the patient's prolonged follow-up period render this case of significant interest.
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Affiliation(s)
- Mara B Antonoff
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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30
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In Vitro Analysis of Polymer Candidates for the Development of Absorbable Vascular Filters. J Vasc Interv Radiol 2012; 23:1023-30. [DOI: 10.1016/j.jvir.2012.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/27/2012] [Accepted: 05/08/2012] [Indexed: 11/20/2022] Open
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31
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Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S-e496S. [PMID: 22315268 PMCID: PMC3278049 DOI: 10.1378/chest.11-2301] [Citation(s) in RCA: 2471] [Impact Index Per Article: 205.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This article addresses the treatment of VTE disease. METHODS We generated strong (Grade 1) and weak (Grade 2) recommendations based on high-quality (Grade A), moderate-quality (Grade B), and low-quality (Grade C) evidence. RESULTS For acute DVT or pulmonary embolism (PE), we recommend initial parenteral anticoagulant therapy (Grade 1B) or anticoagulation with rivaroxaban. We suggest low-molecular-weight heparin (LMWH) or fondaparinux over IV unfractionated heparin (Grade 2C) or subcutaneous unfractionated heparin (Grade 2B). We suggest thrombolytic therapy for PE with hypotension (Grade 2C). For proximal DVT or PE, we recommend treatment of 3 months over shorter periods (Grade 1B). For a first proximal DVT or PE that is provoked by surgery or by a nonsurgical transient risk factor, we recommend 3 months of therapy (Grade 1B; Grade 2B if provoked by a nonsurgical risk factor and low or moderate bleeding risk); that is unprovoked, we suggest extended therapy if bleeding risk is low or moderate (Grade 2B) and recommend 3 months of therapy if bleeding risk is high (Grade 1B); and that is associated with active cancer, we recommend extended therapy (Grade 1B; Grade 2B if high bleeding risk) and suggest LMWH over vitamin K antagonists (Grade 2B). We suggest vitamin K antagonists or LMWH over dabigatran or rivaroxaban (Grade 2B). We suggest compression stockings to prevent the postthrombotic syndrome (Grade 2B). For extensive superficial vein thrombosis, we suggest prophylactic-dose fondaparinux or LMWH over no anticoagulation (Grade 2B), and suggest fondaparinux over LMWH (Grade 2C). CONCLUSION Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
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Affiliation(s)
- Clive Kearon
- Department of Medicine and Clinical Epidemiology and Biostatistics, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Medicine, Family Medicine, and Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY.
| | | | - Paolo Prandoni
- Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Henri Bounameaux
- Department of Medical Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Samuel Z Goldhaber
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael E Nelson
- Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael K Gould
- Department of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Mark Crowther
- Department of Medicine, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Susan R Kahn
- Department of Medicine and Clinical Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
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Removal of Fractured Inferior Vena Cava Filters: Feasibility and Outcomes. J Vasc Interv Radiol 2012; 23:181-7. [DOI: 10.1016/j.jvir.2011.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/14/2011] [Accepted: 10/16/2011] [Indexed: 11/18/2022] Open
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Meisner RJ, Labropoulos N, Gasparis AP, Lampl J, Xu M, Tassiopoulos AK. Review of indications and practices of vena caval filters at a large university hospital. Vasc Endovascular Surg 2011; 46:21-5. [PMID: 22156155 DOI: 10.1177/1538574411422274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vena caval filter (VCF) use has been increasing in recent years. Prophylactic VCF placement has been applied liberally in high-risk patients. METHODS Consecutive patients with VCF placement over a 2-year period at a university hospital were reviewed. RESULTS A total of 244 patients underwent VCF placement in 2 years. Of all, 54% of the patients had the VCF placed for an absolute indication, 14% for a relative indication, and 32% for prophylaxis. Only 14 (9%) of the retrievable filters were removed. Eight patients had a complication of VCF placement; there were no complications of filter retrieval. Vena caval filter placement for prophylaxis alone was 57% from the division of trauma and surgical critical care, 18.3% from interventional radiology department, and 5.2% from the division of vascular surgery. CONCLUSIONS This study indicates that many VCFs are placed for prophylaxis. A low percentage of VCFs was retrieved. This may be the practice at many other large university-based hospitals, necessitating strategies for reducing their placement.
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Affiliation(s)
- Robert J Meisner
- Vascular Surgery Division, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA.
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Gasparis AP, Spentzouris G, Meisner RJ, Elitharp D, Labropoulos N, Tassiopoulos A. Improving retrieval rates of temporary inferior vena cava filters. J Vasc Surg 2011; 54:34S-8S.e1. [DOI: 10.1016/j.jvs.2011.05.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 10/17/2022]
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35
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Retrievable Inferior Vena Cava Filters: Factors that Affect Retrieval Success. Cardiovasc Intervent Radiol 2011; 35:1059-65. [DOI: 10.1007/s00270-011-0268-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/18/2011] [Indexed: 10/15/2022]
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36
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Performance Quality Improvement Projects: Suggestions for Interventional Radiologists. J Am Coll Radiol 2011; 8:585-7. [DOI: 10.1016/j.jacr.2011.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 04/13/2011] [Indexed: 11/22/2022]
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Abdel-Razeq H, Mansour A, Ismael Y, Abdulelah H. Inferior vena cava filters in cancer patients: to filter or not to filter. Ther Clin Risk Manag 2011; 7:99-102. [PMID: 21479140 PMCID: PMC3071346 DOI: 10.2147/tcrm.s17912] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose: Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE); active cancer accounts for almost 20% of all newly diagnosed VTE. Inferior vena cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high-risk situations. In this report, and utilizing a case study, we will address the appropriate utilization of such filters in cancer patients. Methods: The case of a 43-year-old female patient with rectal cancer, who developed deep vein thrombosis following a complicated medical course, will be presented. The patient was anticoagulated with a low molecular weight heparin, but a few months later and following an episode of bleeding, an IVC filter was planned. Using the PubMed database, articles published in English language addressing issues related to IVC filters in cancer patients were accessed and will be presented. Results: Many recent studies questioned the need to insert IVC filters in advanced-stage cancer patients, particularly those whose anticipated survival is short and prevention of PE may be of little clinical benefit and could be a poor utilization of resources. Conclusion: Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or pulmonary embolism is high, IVC filters can be utilized. However, placement of such filters should take into consideration the stage of disease and life expectancy of such patients.
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