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Cherfan P, Zaghloul MS, Abdul-Malak OM, Saadeddin Z, Go C, Hager E, Chaer RA, Avgerinos ED. Stenting across inferior vena cava filters can be a safe and effective alternative to complex retrieval. J Vasc Surg Venous Lymphat Disord 2023; 11:302-309. [PMID: 35995330 PMCID: PMC10805110 DOI: 10.1016/j.jvsv.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Venous stenting for acute and chronic venous disease has been increasingly used as more evidence has accumulated on the efficacy and durability of these interventions for symptomatic patients. Inferior vena cava (IVC) filters that could have been present for years will often be implicated in the obstructive pathology and removal can be challenging. The purpose of the present study was to evaluate whether stenting across an indwelling IVC filter is a safe and effective alternative to removal. METHODS Consecutive patients who had undergone iliocaval stenting at our institution from 2007 to 2020 were identified and divided into groups stratified by the presence of an IVC filter. The operative notes, venography findings, and the electronic health records were queried to obtain the operative details, patient characteristics, postoperative outcomes, stent patency, and survival outcomes. The primary end point was iliocaval stent patency. The patients were divided into two groups according to the presence of an IVC filter with or without overstenting. We used the χ2 test and survival analysis as appropriate. RESULTS A total of 224 consecutive patients were identified, of whom 71 were found to have undergone iliocaval stenting (age, 48 ± 18 years; 47.9% male; body mass index, 31 ± 9 kg/m2). Of the 71 patients, 15 had had stents placed across an indwelling IVC filter (overstented group) and 56 had not had an IVC filter present (non-overstented group). No differences were found in presentation between the overstented group (acute occlusion, 4 of 15 [26.7%]; chronic occlusion, 8 of 15 [53.3%]; and nonocclusive lesions, 3 of 15 [20%]) and the non-overstented group (acute occlusion, 29 of 56 [52%]; chronic occlusion, 18 of 56 [32%]; nonocclusive lesions, 9 of 56 [16%]; P = .2). Comparisons between the two groups revealed no differences in the baseline characteristics except for age (overstented, 57 ± 15 years; non-overstented, 46 ± 18 years; P = 0.03), preoperative anticoagulation therapy (overstented, 66.6%; non-overstented, 26.9%; P = .01), and bilateral leg symptoms (overstented, 86.7%; non-overstented, 23.2%; P < .001). Primary patency at 30 months was 85.6% in the overstented group and 86.1% in the non-overstented group (P = .78). At follow-up, no adverse events related to filter crushing were reported, and no differences were found in 30-month survival. CONCLUSIONS In our single-center, retrospective study of iliocaval stenting, patients who had undergone overstenting across an indwelling IVC filter had had patency rates similar to those whose stents had been placed with no IVC filter in place. Thus, complex IVC filter removal, when not possible or when the risk of operative complications is too high, can be forgone in favor of stenting across the IVC filter, with no implications on midterm patency or adverse events.
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Affiliation(s)
- Patrick Cherfan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed S Zaghloul
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Othman M Abdul-Malak
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Zein Saadeddin
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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L McDevitt J, T Goldman D, J Bundy J, N Hage A, K Jairath N, J Gemmete J, N Srinivasa R, Chick JFB. Gianturco Z-stent placement for the treatment of chronic central venous occlusive disease: implantation of 208 stents in 137 symptomatic patients. ACTA ACUST UNITED AC 2021; 27:72-78. [PMID: 33090095 DOI: 10.5152/dir.2020.19282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the technical successes, adverse events, and long-term stent patency rates of Gianturco Z-stents for management of chronic central venous occlusive disease. METHODS Overall, 137 patients, with mean age 48.6±16.1 years (range, 16-89 years), underwent placement of Gianturco Z-stents for chronic central venous occlusions. Presenting symptoms included lower extremity edema (n=66, 48.2%), superior vena cava syndrome (n=30, 21.9%), unilateral upper extremity swelling (n=20, 14.6%), hemodialysis fistula or catheter dysfunction (n=11, 8.0%), ascites (n=8, 5.8%), and both ascites and lower extremity edema (n=2, 1.5%). Most common etiologies of central venous occlusion were prior central venous access placement (n=58, 42.3%), extrinsic compression (n=29, 21.2%), and post-surgical anastomotic stenosis (n=27, 19.7%). Number of stents placed, stent implantation location, stent sizes, technical successes, adverse events, need for re-intervention, follow-up evaluation, stent patencies, and mortality were recorded. Technical success was defined as recanalization and stent reconstruction with restoration of in-line venous flow. Adverse events were defined by the Society of Interventional Radiology Adverse Event Classification criteria. Primary and primary-assisted stent patencies were analyzed using Kaplan-Meier analysis. RESULTS In total, 208 Z-stents were placed. The three most common placement sites were the inferior vena cava (n=124, 59.6%), superior vena cava (n=44, 21.2%), and brachiocephalic veins (n=27, 13.0%). Technical success was achieved in 133 patients (97.1%). There were two (1.5%) severe adverse events (two cases of stent migration to the right atrium), one (0.7%) moderate adverse event, and one (0.7%) mild adverse event. Mean follow-up was 43.6±52.7 months. Estimated 1-, 3-, and 5-year primary stent patency was 84.2%, 84.2%, and 82.1%, respectively. Estimated 1-, 3-, and 5-year primary-assisted patency was 92.3%, 89.6%, and 89.6%, respectively. The 30- and 60- day mortality rates were 2.9% (n=4) and 5.1% (n=7), none of which were directly attributable to Z-stent placement. CONCLUSION Gianturco Z-stent placement is safe and effective for the treatment for chronic central venous occlusive disease with durable short- and long-term patencies.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daryl T Goldman
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, New York, USA
| | - Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Neil K Jairath
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Washington Medical Center, Seattle, Washington, USA
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George R, Shanmugham V, Bollineny V, Sutradhar P. Contralateral deep-vein thrombosis in lliac vein stenting – Incidence, etiology, and prevention. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Banerjee S, Patel HM, Sheorain VK, Grover T, Parakh R. Double Barrel In Situ Recanalization of Thrombosed Nonretrievable IVC filter. Ann Vasc Surg 2016; 33:229.e11-5. [DOI: 10.1016/j.avsg.2015.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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Barbin CM, Grayburn PA, Choi JW. Successful MitraClip® implantation after angioplasty of a chronic inferior vena cava filter thrombosis. Catheter Cardiovasc Interv 2015; 87:1333-1337. [DOI: 10.1002/ccd.25995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Clay M. Barbin
- Department of Internal Medicine; Baylor University Medical Center; Dallas Texas
| | - Paul A. Grayburn
- Division of Cardiology; Baylor Heart and Vascular Hospital, Baylor University Medical Center; Dallas Texas
| | - James W. Choi
- Division of Cardiology; Baylor Heart and Vascular Hospital, Baylor University Medical Center; Dallas Texas
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Xiao L, Shen J, Tong JJ, Zhang Z, Mu XL, Yi ZJ, Bai S, Xu K. Transcatheter thrombolytic therapy for symptomatic thrombo-occlusion of inferior vena cava filter. Exp Ther Med 2012; 5:533-538. [PMID: 23403505 PMCID: PMC3570124 DOI: 10.3892/etm.2012.843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/19/2012] [Indexed: 01/26/2023] Open
Abstract
Thrombus within an inferior vena cava (IVC) filter reduces filter patency and venous return from the lower extremities, and may progress to complete IVC occlusion. The clinical experiences and outcomes of transcatheter thrombolytic therapy for symptomatic IVC thrombosis following filter implantation have not been widely reported. The aim of the current study was to evaluate the efficiency and safety of trans-catheter thrombolysis for the treatment of symptomatic IVC thrombosis in patients with implanted IVC filters. Transcatheter thrombolysis was used to treat 5 patients with thrombosis of the filter-bearing IVC causing symptoms in 10 limbs from October 2005 to September 2010. The patients were implanted with a second IVC filter through the right internal jugular vein, followed by recanalization of the occluded IVC and intravenous transcatheter thrombolysis. The IVC filters were retrieved through the femoral or right internal jugular vein after the thrombus had dissolved. Technical and clinical outcome, complications and postoperative pulmonary embolism were monitored. A total of 5 filters were implanted and 6 filters were retrieved later. Technically and clinically successful recanalization and thrombolysis were achieved in 5 of 5 patients and 10 of 10 symptomatic limbs. The median thrombolysis period was 13 days (range, 8-14 days). The median dwell time for the filters that were removed was 50.5 days (range, 14-73 days). No major bleeding occurred during the current study. During clinical follow-up, no clinically detectable pulmonary embolism was observed. Endovascular recanalization and transcatheter thrombolysis of IVC thrombosis are efficient, feasible and safe in the presence of an IVC filter.
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Affiliation(s)
- Liang Xiao
- Department of Radiology, The First Hospital of China Medical University, Liaoning, Shenyang 110001
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Chen Z, Zhan F, Fan Y, Deng X. A novel way to reduce thrombus build-up in vena cava filters. Catheter Cardiovasc Interv 2012; 78:792-8. [PMID: 21523890 DOI: 10.1002/ccd.23107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES AND BACKGROUND The build-up of thromboses in vena cava filters after deployment presents serious problem to the patients. We proposed a novel way to overcome this problem in a belief that intentionally induced swirling flow can optimize blood flow patterns in vena cava filters, enhance the stirring motion of flow, in turn accelerate the dissolution of blood clots captured in the filter and facilitate blood to flow pass through the filters. METHODS In this study, we experimentally compared the work efficiency of a vena cava filter under swirling flow condition with that of the same filter under normal flow condition. RESULTS The results show that when compared to the normal flow, the swirling flow indeed has a significantly beneficial effect on a VCF which can decrease its flow-out time nearly 40% and reduce clot build-up in the filter more than 50%. CONCLUSIONS We therefore believe that the design of an ideal VCF should take how to create swirling flow in the filter into the consideration.
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Affiliation(s)
- Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Abstract
Anticoagulation has been proven to be effective in preventing and treating deep vein thrombosis and pulmonary embolus. However, many critically ill patients are unable to receive anticoagulation or suffer recurrent venous thromboembolism despite adequate treatment. This article examines the use of vena cava filters in the critically ill. Indications for, techniques, and complications of vena cava filter insertion are reviewed. The importance of vena cava filters with the option to be retrieved and bedside insertion in the intensive care unit is emphasized.
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Affiliation(s)
- Lindsay M Fairfax
- Department of Surgery, Carolinas Medical Center, Charlotte, NC 28232, USA
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Chen Z, Fan Y, Deng X. A novel deployment design of vena cava filters might be the solution to their blockage problem. Med Hypotheses 2011; 77:990-2. [PMID: 21903340 DOI: 10.1016/j.mehy.2011.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/14/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
Abstract
The blockage of a vena cava filter (VCF) by the captured blood clots presents a serious problem to the patients. Commercially available cone-shaped VCFs such as the Gunther Tulip filter has an inherent structural flaw that leads the captured blood clots to be trapped in their front spire areas where the flow-induced shear stress is relatively low so that the clots cannot dissolve fast enough and will accumulate, gradually block the central passages of the filters. It is well known that for a Hagen-Poiseuille flow in a circular tube, the flow-induced shear stress is highest at the wall of the tube and lowest along its axis. Herein, we hypothesize that by reversely deploying a cone-shaped filter in the vena cava, the filter's blockage problem might be prevented. First of all, this kind of deployment scenario can force the captured blood clots to stay in the peripheral areas of the vena cava and keep the central passage of the filter unblocked. Secondly, this scenario can expose the captured blood clots to relatively high shear stress that may dissolve the clots faster.
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Affiliation(s)
- Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing 100191, China
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Proctor MC, Greenfield LJ. Form And Function Of Vena Cava Filters: How Do Optional Filters Measure Up? Vascular 2008; 16:10-6. [DOI: 10.2310/6670.2008.00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The function of vena cava filters, preventing pulmonary embolism while maintaining caval patency, is associated with the design. Several characteristics have been reported. This report evaluates retrievable filter designs in comparison with previously marketed designs with respect to efficacy and safety. Three inferior vena cava (IVC) filters (Gunther Tulip, Bard Recovery, and the Cordis OptEase) were compared on the basis of design characteristics associated with function, shape, number of trapping levels, and fixation. Adverse events reported in the literature and to the US Food and Drug Administration Manufacturers and User Facility Device Experience Database (MAUDE) were summarized. The major differences among device types include the fixation, the volume and number of trapping levels, and the amount of metal in the IVC. The MAUDE registry reported adverse events that had been hypothesized from the analysis of in vitro and in vivo testing. The Recovery and OptEase filters had the highest number of clinically important reports. From 12 to 57% were retrieved between 3 days and 11 months. Adaptations made to facilitate retrieval led to unacceptable sequelae. The small number removed, the length of time they are left in place, and the risks associated with retrieval suggest that optional filters may not be equivalent to approved permanent devices.
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Affiliation(s)
- Mary C. Proctor
- *Department of Surgery, University of Michigan, Ann Arbor, MI
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Stecker MS, Chahin C. Transpopliteal removal of an OptEase inferior vena cava filter after treatment of symptomatic filter thrombosis. J Endovasc Ther 2007; 14:411-5. [PMID: 17723009 DOI: 10.1583/06-1999.1] [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: 10/23/2022]
Abstract
PURPOSE To describe a case of transpopliteal retrieval of an inferior vena cava (IVC) filter. CASE REPORT A paraplegic patient had an IVC filter placed for deep venous thrombosis (DVT) after anticoagulant therapy was stopped. Two weeks later, he developed massive scrotal and bilateral lower extremity swelling due to iliocaval thrombosis, which was treated by power pulse-spray thrombectomy and catheter-directed thrombolytic infusion via bilateral popliteal approaches. Following successful thrombus removal, the filter was uniquely retrieved via the right popliteal access; the patient was discharged on warfarin anticoagulation. CONCLUSION Transpopliteal IVC filter retrieval is feasible and may be a useful alternative technique in selected instances.
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Affiliation(s)
- Michael S Stecker
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Abstract
Pulmonary emboli in a critically ill patient population is an occurrence that may be reduced with appropriate utilization of inferior vena cava (IVC) filters. Complications both during transfer or transport of critically ill patients who are dependent upon multiple intravenous drips, ventilators and intensive monitoring may be reduced with bedside placement of inferior vena cava filters. Over the last decade, investigators have been developing techniques for bedside IVC filter placement based on intravascular ultrasound techniques. We discuss and detail a single venous access technique of IVC filter placement using intravascular ultrasound.
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Affiliation(s)
- Andy C Chiou
- Endovascular Surgery Section, Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61603, USA.
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Zhou W, Bush RL, Lin PH, Lumsden AB. Inferior Vena Cava Occlusion Secondary to Filter Placement: Endovascular Therapy. J Endovasc Ther 2004; 11:747-8. [PMID: 15615568 DOI: 10.1583/04-1392.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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