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Choi PJ, Kabeil M, Furtado Neves PJ, Labropoulos N, Zil-E-Ali A, Aziz F, Malgor EA, Malgor RD. Urological complications caused by inferior vena cava filters: a systematic review. INT ANGIOL 2024; 43:247-254. [PMID: 38619204 DOI: 10.23736/s0392-9590.24.05041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review. EVIDENCE ACQUISITION A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication. EVIDENCE SYNTHESIS Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported. CONCLUSIONS Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.
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Affiliation(s)
- Paul J Choi
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Pedro J Furtado Neves
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Ahsan Zil-E-Ali
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Faisal Aziz
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Emily A Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Rafael D Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA -
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Victory JH, Minc SD, Zaslau S, Elbakry AA, Almenoff MI. Open retrieval management of inferior vena cava filter erosion resulting in symptomatic hydroureteronephrosis. J Vasc Surg Cases Innov Tech 2023; 9:101188. [PMID: 37799839 PMCID: PMC10547826 DOI: 10.1016/j.jvscit.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/28/2023] [Indexed: 10/07/2023] Open
Abstract
Inferior vena cava filters are effective for the management of thromboembolic disease but can erode into adjacent organ systems in rare instances. Endovascular retrieval of eroded filters has been the preferred management for this complication. We present a case for which endovascular retrieval was not appropriate because of filter orientation and erosion into the ureter and describe successful management using open retrieval of a permanent filter with erosion into the renal collecting system requiring reconstruction. Although minimally invasive retrieval is preferred over open repair, this approach should be considered when filter erosion is not amenable to endovascular retrieval.
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Affiliation(s)
| | - Samantha D. Minc
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Stanley Zaslau
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV
| | - Amr A. Elbakry
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV
| | - Maxwell Ian Almenoff
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, WV
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Goldman DT, Conway AM, Tran NN, Stoffels G, Vismer M, Giangola G, Carroccio A. Extreme obesity is associated with angulation during inferior vena cava filter placement. J Vasc Surg Venous Lymphat Disord 2020; 8:594-600. [PMID: 31926822 DOI: 10.1016/j.jvsv.2019.10.022] [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: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placement of inferior vena cava (IVC) filters can be complicated by venous injury, filter misplacement, angulation, insertion site injury, and procedure-related death. Currently, no studies exist evaluating the correlation between obesity and adverse outcomes of IVC filters. We aimed to assess the outcomes of IVC filter placement in the obese population using the Vascular Quality Initiative database. METHODS The Vascular Quality Initiative registry identified 7258 patients who underwent IVC filter placement from January 2013 to June 2017. Patients were divided into three groups based on their body mass index (BMI): normal/overweight (BMI <30), obese (BMI 30-40), and extremely obese (BMI >40). Periprocedural outcomes were analyzed. RESULTS The mean age was 63.6 ± 16.6 years and 3444 patients (47%) were female. BMI was less than 30 in 4115 (56.7%), 30 to 40 in 2148 (29.6%), and greater than 40 in 995 (13.7%) patients. A complication or IVC filter-related death occurred in 142 patients (2.6%). Adverse events included angulation (1.3%), IVC filter misplacement (0.5%), insertion site injury (0.3%), IVC filter-related death (0.1%), and venous injury (0.06%). In multivariable analysis, increased BMI was found to be associated with angulation (P = .03), but was not associated with IVC filter misplacement (P = .43), or any complication or IVC filter-related death (P = .22). A subgroup analysis of IVC filter placements using only fluoroscopy demonstrated that the risk of angulation was significantly higher in patients with a BMI of greater than 40 compared with a BMI of less than 30 (odds ratio, 2.12; 95% confidence interval, 1.07-4.21; P = .03). There was not enough evidence to conclude that BMI was associated with any other outcome. CONCLUSIONS IVC filter insertion has low complication rates. Increased BMI is associated with an increased risk of IVC filter angulation; there is no evidence of association between BMI and other periprocedural complications.
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Affiliation(s)
- Daryl T Goldman
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
| | - Allan M Conway
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Nhan Nguyen Tran
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Guillaume Stoffels
- The Feinstein Institute for Medical Research, Northwell Health, New York, NY
| | - Marta Vismer
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Gary Giangola
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alfio Carroccio
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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Ding PX, Han XW, Liu C, Ren KW. Inferior vena cava filter misplacement in the right ovarian vein and successful removal by loop-snare technique in a patient with inferior vena cava agenesis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:324-326. [PMID: 30761379 PMCID: PMC6298937 DOI: 10.1016/j.jvscit.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/14/2017] [Indexed: 11/04/2022]
Abstract
Misplacement of an inferior vena cava (IVC) filter in a gonadal vein is a rare complication of IVC filter placement. We report a case of a filter misplaced in the ovarian vein of a pregnant woman with agenesis of the infrarenal IVC and bilateral lower extremity deep venous thrombosis. The filter was removed by a loop-snare technique through an internal jugular vein. IVC agenesis and dilated right gonadal vein should be kept in mind when an IVC filter is being inserted in the infrarenal location through the jugular approach.
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Affiliation(s)
- Peng-Xu Ding
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Wei Han
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Liu
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke-Wei Ren
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Qin X, Lu C, Ren P, Gu J, Zheng Y, Yu C, Wang J, Xie M. New method for ultrasound-guided inferior vena cava filter placement. J Vasc Surg Venous Lymphat Disord 2018; 6:450-456. [PMID: 29602758 DOI: 10.1016/j.jvsv.2017.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/15/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Transabdominal ultrasound (TAUS)-guided inferior vena cava filter (IVCF) placement currently uses an inferior vena cava (IVC) longitudinal plane with cross-section of the right renal artery or the transverse plane of the right renal vein (RRV)-IVC intersection. The goal of this study was to introduce a new method for TAUS-guided IVCF placement. METHODS The study enrolled patients who were at high risk for or had pulmonary embolism from October 22, 2010, to June 30, 2016. The probe was positioned on the right flank to centralize the RRV-IVC junction during imaging and to permit a straight line through the midpoint of the probe on the surface and a parallel line 1.0 cm below the straight line as a marker. The probe was subsequently placed on the abdominal wall with the upper edge at the marker line to show the long axis of the IVC during the process of filter placement. The upper edge of the probe was considered the filter tip position. RESULTS A total of 1029 patients were evaluated, and 98 patients (9.5%) were excluded because of poor IVC visualization (n = 14 [1.4%]), IVC or bilateral iliac vein thrombosis (n = 79 [7.7%]), and unsuitable anatomy (n = 5 [0.5%]). The remaining 931 patients (90.5%) were selected for TAUS-guided IVCF placement, and all filters (100%) were successfully placed. There were no procedure-related complications. Suprarenal IVCF was observed in 4 patients (0.4%) by computed tomography, and the filter tip exceeded the upper edge of L2 in 15 patients (1.6%) by plain film radiography; one of them had two RRVs. Severe filter tilting (20.8 degrees) occurred in one patient. CONCLUSIONS This new method of TAUS-guided IVCF placement was simple, safe, and effective. It may be widely applied for the bedside placement of vena cava filters.
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Affiliation(s)
- Xiaojuan Qin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengfa Lu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pingping Ren
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Jin Gu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zheng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Yu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Abstract
Inferior vena cava (IVC) filter placement is a relatively low risk alternative for prophylaxis against pulmonary embolism in patients with pelvic or lower extremity deep venous thrombosis who are not suitable for anticoagulation. There is an increasing trend in the number of IVC filter implantation procedures performed every year. There are many device types in the market and in the early 2000s, the introduction of retrievable filters brought an additional subset of complications to consider. Modern filter designs have led to decreased morbidity and mortality, however, a thorough understanding of the limitations and complications of IVC filters is necessary to weight the risks and benefits of placing IVC filters. In this review, the complications associated with IVC filters are divided into procedure related, post-procedure, and retrieval complications. Differences amongst the device types and retrievable filters are described, though this is limited by a significant lack of prospective studies. Additionally, the clinical presentation as well as prevention and treatment strategies are outlined with each complication type.
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Affiliation(s)
- Simer Grewal
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Murthy R Chamarthy
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Locke N, Duchene D, Padmanabhan P. Inferior Vena Cava Filter Erosion Causing Symptomatic Obstructive Hydronephrosis. J Endourol Case Rep 2016; 2:138-40. [PMID: 27579443 PMCID: PMC4996617 DOI: 10.1089/cren.2016.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Transcaval inferior vena cava (IVC) filter penetration involving the urinary tract is rare, but has been previously reported. We herein present unique management of symptomatic hydronephrosis secondary to erosion of an IVC filter limb into the lumen of the proximal right ureter. Case Presentation: A 59-year-old woman presented with abdominal and right flank pain in October 2015 and was found to have right hydronephrosis, apparently secondary to obstruction from erosion of an IVC filter limb into the proximal right ureter. This was effectively managed with percutaneous, endovascular, and endourologic procedures, without the need for a major invasive surgical procedure. Conclusion: Endovascular removal of the IVC filter was performed safely in this case and can be considered when the urinary tract is involved in filter erosion.
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Affiliation(s)
- Nathan Locke
- Department of Urology, University of Kansas, Kansas City, Kansas
| | - David Duchene
- Department of Urology, University of Kansas, Kansas City, Kansas
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