1
|
Covello B, Radvany M. Back to the Basics: Inferior Vena Cava Filters. Semin Intervent Radiol 2022; 39:226-233. [PMID: 36062224 PMCID: PMC9433154 DOI: 10.1055/s-0042-1751294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Inferior vena cava filters are an important therapeutic option for patients with venous thromboembolism and contraindication to anticoagulation. Indications for filter placement have varied over the previous decades. This article discusses the history of inferior vena cava filter use, with a basic overview of technology and specific devices. Finally, this article reviews emerging filter design and technology. Understanding the basics of inferior vena cava filters is critical to building more robust clinical data for the purpose of improving patient outcomes.
Collapse
Affiliation(s)
- Brian Covello
- Department of Interventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
| | - Martin Radvany
- Department of Neurointerventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
| |
Collapse
|
2
|
Current Controversies in Inferior Vena Cava Filter Placement: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2020; 216:563-569. [PMID: 33206563 DOI: 10.2214/ajr.20.24817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.
Collapse
|
3
|
Sweeney J, Parikh N. Inferior vena cava filter placement in a left IVC and drainage into duplicated SVC via hemiazygous continuation. Radiol Case Rep 2018; 13:320-323. [PMID: 29904464 PMCID: PMC5999865 DOI: 10.1016/j.radcr.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/15/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022] Open
Abstract
Left-sided inferior vena cava (IVC) is the second most common anatomical anomaly of the IVC. We report a drainage pattern of the left IVC into a left duplicated superior vena cava (SVC) diagnosed during IVC filter placement consultation. The patient was a 66-year-old man with symptomatic hematuria caused by bladder cancer diagnosed with IVC thrombus and a left IVC found on a staging computed tomography urogram. The patient underwent computed tomography pulmonary angiogram, which ruled out pulmonary embolism, but demonstrated hemiazygous continuation of the left IVC above the diaphragm to meet a persistent left SVC (prevalence approximately 0.3%-0.5%) (Kim et al. 1995) [1] emptying into the right atrium via the coronary sinus. We report a novel drainage pattern of the left IVC into a duplicated left SVC via hemiazygous continuation.
Collapse
|
4
|
Bikdeli B, Wang Y, Minges KE, Desai NR, Kim N, Desai MM, Spertus JA, Masoudi FA, Nallamothu BK, Goldhaber SZ, Krumholz HM. Vena Caval Filter Utilization and Outcomes in Pulmonary Embolism: Medicare Hospitalizations From 1999 to 2010. J Am Coll Cardiol 2016; 67:1027-1035. [PMID: 26940921 DOI: 10.1016/j.jacc.2015.12.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inferior vena caval filters (IVCFs) may prevent recurrent pulmonary embolism (PE). Despite uncertainty about their net benefit, patterns of use and outcomes of these devices in contemporary practice are unknown. OBJECTIVES The authors determined the trends in utilization rates and outcomes of IVCF placement in patients with PE and explored regional variations in use in the United States. METHODS In a national cohort study of all Medicare fee-for-service beneficiaries ≥65 years of age with principal discharge diagnoses of PE between 1999 and 2010, rates of IVCF placement per 100,000 beneficiary-years and per 1,000 patients with PE were determined. The 30-day and 1-year mortality rates after IVCF placement were also investigated. RESULTS Among 556,658 patients hospitalized with PE, 94,427 underwent IVCF placement. Between 1999 and 2010, the number of PE hospitalizations with IVCF placement increased from 5,003 to 8,928, representing an increase in the rate per 100,000 beneficiary-years from 19.0 to 32.5 (p < 0.001 for both). As the total number of PE hospitalizations increased (from 31,746 in 1999 to 54,392 in 2010), the rate of IVCF placement per 1,000 PE hospitalizations did not change significantly (from 157.6 to 164.1, p = 0.11). Results were consistent across demographic subgroups, although IVCF use was higher in blacks and patients ≥85 years of age. IVCF utilization varied widely across regions, with the highest rate in the South Atlantic region and the lowest rate in the Mountain region. CONCLUSIONS In a period of increasing PE hospitalizations among Medicare fee-for-service beneficiaries, IVCF placement increased as utilization rates in patients with PE remained greater than 15%. Mortality associated with PE hospitalizations is declining, regardless of IVCF use.
Collapse
Affiliation(s)
- Behnood Bikdeli
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Graduate School of Arts and Sciences, Yale University, New Haven, Connecticut
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy Kim
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| |
Collapse
|
5
|
Kim YK, Chun HJ, Hwang JK, Kim JI, Kim SD, Park SC, Moon IS. Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis. Asian J Surg 2016; 39:178-81. [DOI: 10.1016/j.asjsur.2013.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/15/2012] [Accepted: 07/09/2013] [Indexed: 11/29/2022] Open
|
6
|
Partovi S, Davidson JC, Patel IJ. Implications and limitations of the PREPIC2 study-the interventionist's perspective. Cardiovasc Diagn Ther 2016; 6:259-61. [PMID: 27280089 DOI: 10.21037/cdt.2016.01.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sasan Partovi
- Department of Radiology, Section of Vascular & Interventional Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jon C Davidson
- Department of Radiology, Section of Vascular & Interventional Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Indravadan J Patel
- Department of Radiology, Section of Vascular & Interventional Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| |
Collapse
|
7
|
Lee SH, Kim HK, Hwang JK, Kim SD, Park SC, Kim JI, Won YS, Youn SS, Moon IS. Efficacy of Retrievable Inferior Vena Cava Filter Placement in the Prevention of Pulmonary Embolism during Catheter-Directed Thrombectomy for Proximal Lower-Extremity Deep Vein Thrombosis. Ann Vasc Surg 2016; 33:181-6. [PMID: 26806235 DOI: 10.1016/j.avsg.2015.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/07/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) filter placement is not indicated for thrombolytic interventional treatment for deep vein thrombosis (DVT). We analyzed the efficacy and feasibility of retrievable IVC filter placement for the preventive management of embolic shedding during catheter-directed thrombectomy (CDT) for DVT of lower extremity. METHODS Seventy patients (35 males and 35 females) who underwent retrievable IVC filter placement to prevent thrombus dislodgement during CDT in all symptomatic DVT with thrombus age suspected within 4 weeks of the lower extremity between March 2008 and January 2014 were included in this study. All patients underwent laboratory blood study, duplex ultrasound and/or computed tomography for diagnosis, treatment, and follow-up in accordance with treatment policy of our Uijeongbu St. Mary's hospital. Two types of retrievable IVC filters (OptEase Filter, Cordis, Roden, The Netherlands; Gunther Tulip Filter, Cook, Bloomington, IN) were used to prevent thromboembolic events during CDT. After filter placement, subcutaneous low-molecular-weight heparin and overlapped to warfarin or new oral anticoagulant tried to achieve a target international normalized ratio (INR) of 2.0-3.0 in warfarin patients. RESULTS The thrombus was dislodged through the IVC filter during catheter-directed thrombolytic therapy in 22 patients (31.4%). In 22 cases, the thromboses were trapped by the retrievable IVC filter, and follow-up images showed thrombus capture. Thirty-four patients (48.6%) received percutaneous transluminal angioplasty (PTA). Additional stents were inserted in 23 patients (32.8%). Pulmonary embolism (PE) was not observed in patients implanted with retrievable IVC filters. CONCLUSIONS Our study findings suggest that retrieval IVC filter placement during interventional treatments of DVT of lower extremity such as thrombectomy of vein thrombus with or without stent insertion at compressed deep vein is favorable and effective for protecting against PE or lethal complications. We recommend carefully that before the management of DVT thrombus of lower extremity, retrieval IVC filter placement should be considered for preventing morbidity related with the PE.
Collapse
Affiliation(s)
- Seul-Hee Lee
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeung-Kee Hwang
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Dong Kim
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Cheol Park
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Ji-Il Kim
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Sung Won
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Seob Youn
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Sung Moon
- Division of Vascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
8
|
Molvar C. Inferior vena cava filtration in the management of venous thromboembolism: filtering the data. Semin Intervent Radiol 2013; 29:204-17. [PMID: 23997414 DOI: 10.1055/s-0032-1326931] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is a common cause of morbidity and mortality. This is especially true for hospitalized patients. Pulmonary embolism (PE) is the leading preventable cause of in-hospital mortality. The preferred method of both treatment and prophylaxis for VTE is anticoagulation. However, in a subset of patients, anticoagulation therapy is contraindicated or ineffective, and these patients often receive an inferior vena cava (IVC) filter. The sole purpose of an IVC filter is prevention of clinically significant PE. IVC filter usage has increased every year, most recently due to the availability of retrievable devices and a relaxation of thresholds for placement. Much of this recent growth has occurred in the trauma patient population given the high potential for VTE and frequent contraindication to anticoagulation. Retrievable filters, which strive to offer the benefits of permanent filters without time-sensitive complications, come with a new set of challenges including methods for filter follow-up and retrieval.
Collapse
|
9
|
Ni H, Win LL. Retrievable inferior vena cava filters for venous thromboembolism. ISRN RADIOLOGY 2013; 2013:959452. [PMID: 24967292 PMCID: PMC4045516 DOI: 10.5402/2013/959452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022]
Abstract
Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability.
Collapse
Affiliation(s)
- Han Ni
- Internal Medicine, Faculty of Medicine, SEGi University, No. 9 Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor, Malaysia
| | - Lei Lei Win
- Paediatrics, Faculty of Medicine, SEGi University, No. 9 Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor, Malaysia
| |
Collapse
|
10
|
Affiliation(s)
- Brian Funaki
- Section of Vascular and Interventional Radiology, University of Chicago Hospitals, Chicago, Illinois
| |
Collapse
|