Inferior vena cava filter insertion

Complications and Retrieval Data of Vena Cava Filters Based on Specific Infrarenal Location

PURPOSE

Although recommended placement of IVC filters is with their tips positioned at the level of the renal vein inflow, in practice, adherence is limited due to clinical situation or IVC anatomy. We seek to evaluate the indwelling and retrieval complications of IVC filters based on their specific position within the infrarenal IVC.

MATERIALS AND METHODS

Retrospective, single institution study of 333 consecutive infrarenal vena cava filters placed by interventional radiologists in patients with an average age of 62.2 ± 15.7 years was performed between 2013 and 2015. Primary indication was venous thromboembolic disease (n = 320, 96.1%). Filters were classified based on location of the apex below the lowest renal vein inflow on the procedural venogram: less than 1 cm (n = 180, 54.1%), 1-2 cm (n = 96, 28.8%), and greater than 2 cm (n = 57, 17.1%). Denali (n = 171, 51.4%) and Celect (n = 162, 48.6%) filters were evaluated. CT follow-up, indwelling complications, and retrieval data were obtained.

RESULTS

Follow-up CT imaging performed for symptomatic indications occurred for 38.3% of filters placed < 1 cm below the lowest renal vein, 27.1% of filters placed 1-2 cm, and 36.8% placed > 2 cm (p = .16). There was no difference in caval strut penetration, penetration of adjacent viscera, time to penetration, filter migration, or tilt (p = .15, .27, .41, .57, .93). No filter fractures occurred. There was no difference in the incidence of breakthrough PE or complex filter retrieval (p = .83, .59). Only one retrieval failure occurred.

CONCLUSIONS

This study suggests filter apex location within the infrarenal IVC, including placement > 2 cm below the level of the renal vein inflow, is not associated with differences in indwelling or retrieval complications.

LEVEL OF EVIDENCE

Level 3 non-randomized controlled follow-up study.

Prevention of pulmonary embolisms associated with vena cava filter implantation

OBJECTIVE

To investigate the prevention of pulmonary embolism (PE) by the implantation of inferior vena cava filters (IVCFs).

METHODS

Data of 1058 patients treated for lower extremity deep vein thrombosis (DVT) between January 2005 and January 2012 were analyzed retrospectively and divided into those with and without PE.

RESULTS

Of the 1058 patients, 34 had PEs (3.2%) and 1024 did not. Multivariable analyses showed that PEs were less likely to occur in patients with IVCFs than in those without IVCFs (odd ratio [OR] =  0.028, P < 0.001), and were more likely to occur in patients with vena cava thrombosis than in those without vena cava thrombosis (OR =  19.094, P < 0.001). Analyses stratified by DVT site showed that vena cava thrombosis was the only risk factor of PE for patients with a left DVT (crude OR =  12.814, P < 0.001), and IVCF implantation was the only protective factor for PE for patients with a right or bilateral DVT (crude OR =  0.028, P =  0.001). IVCF patency rate for follow-up was 98.7% with no filter migration, declination, or failure of expansion.

CONCLUSIONS

IVCFs can reduce the occurrence of PEs in patients with DVTs.

Vena caval thrombosis after trauma to the liver

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.