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Visconti L, Celi A, Carrozzi L, Tinelli C, Crocetti L, Daviddi F, De Caterina R, Madonna R, Pancani R. Inferior vena cava filters: Concept review and summary of current guidelines. Vascul Pharmacol 2024; 155:107375. [PMID: 38663572 DOI: 10.1016/j.vph.2024.107375] [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: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Anticoagulation is the first-line approach in the prevention and treatment of pulmonary embolism. In some instances, however, anticoagulation fails, or cannot be administered due to a high risk of bleeding. Inferior vena cava filters are metal alloy devices that mechanically trap emboli from the deep leg veins halting their transit to the pulmonary circulation, thus providing a mechanical alternative to anticoagulation in such conditions. The Greenfield filter was developed in 1973 and was later perfected to a model that could be inserted percutaneously. Since then, this model has been the reference standard. The current class I indication for this device includes absolute contraindication to anticoagulants in the presence of acute thromboembolism and recurrent thromboembolism despite adequate therapy. Additional indications have been more recently proposed, due to the development of removable filters and of progressively less invasive techniques. Although the use of inferior vena cava filters has solid theoretical advantages, clinical efficacy and adverse event profile are still unclear. This review analyzes the most important studies related to such devices, open issues, and current guideline recommendations.
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Affiliation(s)
- Luca Visconti
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Ospedale "Sacro Cuore di Gesù" Gallipoli, Azienda Sanitaria Locale Lecce, Italy
| | - Alessandro Celi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Camilla Tinelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Crocetti
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Interventional Radiology Unit, University of Pisa, Pisa, Italy
| | - Francesco Daviddi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Interventional Radiology Unit, University of Pisa, Pisa, Italy
| | - Raffaele De Caterina
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Cardiology Unit, Cardio-Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rosalinda Madonna
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa and Cardiology Unit, Cardio-Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roberta Pancani
- Pulmonary Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Lei K, DiCaro MV, Tak N, Turnbull S, Abdallah A, Cyrus T, Tak T. Contemporary Management of Pulmonary Embolism: Review of the Inferior Vena Cava filter and Other Endovascular Devices. Int J Angiol 2024; 33:112-122. [PMID: 38846989 PMCID: PMC11152642 DOI: 10.1055/s-0044-1785231] [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: 06/09/2024] Open
Abstract
Inferior vena cava (IVC) filters and endovascular devices are used to mitigate the risk of pulmonary embolism in patients presenting with lower extremity venous thromboembolism in whom long-term anticoagulation is not a good option. However, the efficacy and benefit of these devices remain uncertain, and controversies exist. This review focuses on the current use of IVC filters and other endovascular therapies in clinical practice. The indications, risks, and benefits are discussed based on current data. Further research and randomized controlled trials are needed to characterize the patient population that would benefit most from these interventional therapies.
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Affiliation(s)
- KaChon Lei
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Michael V. DiCaro
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Nadia Tak
- Research Associate, University of Minnesota - Twin Cities, Minneapolis, Minnesota
| | - Scott Turnbull
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Ala Abdallah
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
| | - Tillman Cyrus
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, North Las Vegas, Nevada
| | - Tahir Tak
- Department of Cardiovascular Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Internal Medicine, Kirk Kerkorian SOM at the University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, North Las Vegas, Nevada
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Bulman JC, Ali H, Sikaria D, Ahmed M, Weinstein JL. The Impact of Implementation of a Commercial Inferior Vena Cava Filter Database Program on Filter Retrieval versus Physician Tracking over a 9-Year Period: A Retrospective, Observational Study. J Vasc Interv Radiol 2024; 35:576-582. [PMID: 38142888 DOI: 10.1016/j.jvir.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023] Open
Abstract
PURPOSE To compare the impact of a commercial tracking database on inferior vena cava filter retrievals with that of physician tracking and no tracking. MATERIALS AND METHODS From January 2013 to December 2021, 532 filters were placed at a single institution and followed in 3 phases: (a) Phase 1, pretracking (January 1, 2013, to February 28, 2015); (b) Phase 2, commercial database tracking (March 1, 2015, to June 30, 2019); and (c) Phase 3, commercial database tracking with separate tracking by an interventional radiologist (July 1, 2019, to December 31, 2021). Patients excluded from the commercial database due to human error served as a control group. Outcomes of commercial database entry, 2-year filter retrieval rates, dwell times, and factors contributing to retrieval candidacy were collected. RESULTS Two-year retrieval rates in Phases 1, 2 and 3 were 20%, 31%, and 46%, respectively (Phase 1 vs 2, P = .04; Phase 2 vs 3, P = .009). Median dwell times across Phases 1, 2, and 3 were 168 days (4-1,313 days), 140 days (3-1,988 days), and 188 days (13-734 days) (P = .33), respectively. There was no difference in retrieval rates (P = .86) and dwell times (P = .50) between patients enrolled in the database group and those enrolled in the control group. Across all phases, 48% of patients enrolled in the database were not successfully contacted, and only 6% were categorized as "likely to consult" filter retrieval. During Phase 3, 100% of patients achieved a retrieval disposition. CONCLUSIONS A commercial tracking database had low success rates of contacting patients and did not increase filter retrieval rates relative to those in the control group; however, physician tracking increased retrieval rates.
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Affiliation(s)
- Julie C Bulman
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | - Hamza Ali
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Dhiraj Sikaria
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jeffrey L Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Watson C, Saaid H, Vedula V, Cardenas JC, Henke PK, Nicoud F, Xu XY, Hunt BJ, Manning KB. Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling. Ann Biomed Eng 2024; 52:467-486. [PMID: 37914979 DOI: 10.1007/s10439-023-03390-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Venous thromboembolism (VTE) is a massive clinical challenge, annually affecting millions of patients globally. VTE is a particularly consequential pathology, as incidence is correlated with extremely common risk factors, and a large cohort of patients experience recurrent VTE after initial intervention. Altered hemodynamics, hypercoagulability, and damaged vascular tissue cause deep-vein thrombosis and pulmonary embolism, the two permutations of VTE. Venous valves have been identified as likely locations for initial blood clot formation, but the exact pathway by which thrombosis occurs in this environment is not entirely clear. Several risk factors are known to increase the likelihood of VTE, particularly those that increase inflammation and coagulability, increase venous resistance, and damage the endothelial lining. While these risk factors are useful as predictive tools, VTE diagnosis prior to presentation of outward symptoms is difficult, chiefly due to challenges in successfully imaging deep-vein thrombi. Clinically, VTE can be managed by anticoagulants or mechanical intervention. Recently, direct oral anticoagulants and catheter-directed thrombolysis have emerged as leading tools in resolution of venous thrombosis. While a satisfactory VTE model has yet to be developed, recent strides have been made in advancing in silico models of venous hemodynamics, hemorheology, fluid-structure interaction, and clot growth. These models are often guided by imaging-informed boundary conditions or inspired by benchtop animal models. These gaps in knowledge are critical targets to address necessary improvements in prediction and diagnosis, clinical management, and VTE experimental and computational models.
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Affiliation(s)
- Connor Watson
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Hicham Saaid
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Jessica C Cardenas
- Department of Surgery and the Center for Translational Injury Research, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Beverley J Hunt
- Department of Thrombosis and Haemostasis, King's College, London, UK
- Thrombosis and Haemophilia Centre, Guy's & St Thomas' NHS Trust, London, UK
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Zhang L, Hu WP, Zhang H, Xia SB, Wang HF, Song C, Lu QS. Retrievable Inferior Vena Cava Filter Trapped Embolus: A Risk Factor of Detachment of Thrombus Analysis Based on a Multicenter Prospective Observational Study. J Endovasc Ther 2023:15266028231205718. [PMID: 37882181 DOI: 10.1177/15266028231205718] [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: 10/27/2023]
Abstract
PURPOSE Up to now, the indications of inferior vena cava filter placement still remain controversial in the academic field. The aim of this study was to determine the risk factors of detachment of thrombus and to evaluate the necessity of inferior vena cava filter placement to prevent fatal pulmonary embolism. MATERIALS AND METHODS A total of 2892 patients participated in the multicenter prospective observational study from January 1, 2018, to December 31, 2018, and underwent retrievable inferior vena cava filter (RIVCF) placement in 103 centers in China. The primary endpoint of the study was RIVCF trapped embolus detected by inferior vena cava venography/ultrasound/computed tomography scanning or visible macroscopic thrombus before or during RIVCF retrieval. The relative factors of RIVCF trapped embolus were analyzed accordingly. RESULTS The average age of the patients was 61.0 (50.0-71.0) years. Retrievable inferior vena cava filter trapped embolus occurred in 308 patients (10.65%). The fracture location, surgery location, and endovascular intervention differed between RIVCF trapped embolus and non-RIVCF trapped embolus groups (p<0.001, respectively). By multivariate analysis, RIVCF trapped embolus were less common in older patients (odds ratio [OR]=0.998; p<0.001) and more common in patients with below-the-knee fracture (OR=1.093, p=0.038), thigh fracture (OR=1.118, p=0.007), and pelvis surgery (OR=1.067, p=0.016). In addition, compared with patients without endovascular intervention, patients with percutaneous mechanical thrombectomy (PMT) + catheter-directed thrombolysis (CDT) were more prone to develop RIVCF trapped embolus (OR=1.060, p=0.010). However, RIVCF trapped embolus was less common in patients with CDT (OR=0.961, p=0.004). CONCLUSIONS Lower limb fracture, pelvis surgery, and PMT + CDT are prone to cause trapped embolus. As a trapped embolus often represents the possibility of severe pulmonary embolism, lower limb fracture, pelvis surgery, and PMT + CDT could be risk factors of fatal pulmonary embolism. Due to the low incidence of trapped embolus, it is not necessary to place filters in elderly patients and CDT-only patients. CLINICAL IMPACT The purpose of this paper is to standardize the use of inferior vena cava filter and avoid unnecessary filter implantation through the summary and analysis of a large number of clinical data. At the same time, more attention should be paid to and active treatment should be given to high-risk groups of pulmonary embolism.
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Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Wen-Ping Hu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
- Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Shi-Bo Xia
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Hong-Fei Wang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
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Sochart S, Baryeh K, Sochart DH. The use of pre-operative Inferior Vena Cava filters for thromboprophylaxis in ultra-high-risk patients undergoing total hip and knee arthroplasty: a systematic review and narrative analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2749-2764. [PMID: 37000238 PMCID: PMC10063930 DOI: 10.1007/s00590-023-03531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Patients undergoing total hip (THA) or knee (TKA) arthroplasty are at high risk of venous thromboembolism (VTE). As the number performed annually increases, the population at risk of fatal pulmonary embolism (PE) also grows. Ultra-high-risk arthroplasty patients (UHRAPs) include those with additional comorbidities, or a history of VTE, for many of whom routine prophylaxis will previously have failed. Pre-operative insertion of Inferior Vena Cava filters (IVCFs) has been recommended for thromboprophylaxis in UHRAPs, and this review was performed to establish their results. METHODS A systematic search of MEDLINE and Embase databases was performed for studies reporting the use of Inferior Vena Cava filters in hip and knee arthroplasty patients. RESULTS Ten studies met the inclusion criteria, containing 718 IVCFs in Orthopaedic patients, 343 of which were permanent (47.8%), 369 potentially retrievable (51.4%), 5 absorbable (0.6%) and one of unknown design (0.1%). Patient age averaged 64.7yrs (17-95) and 56% were female. Pre-operatively, 415 prophylactic IVCFs were inserted in 409 UHRAPs, undergoing a total of 438 total joint arthroplasties (TJA). There were 11 cases of PE in the entire series (1.5%) only one of which was fatal (0.01%), with four non-fatal PE in the UHRAP group (0.96%). Removal was attempted for 283 of the retrievable filters (76.7%) and was successful in 280 (98.9%). CONCLUSION The use of IVCFs eliminated fatal PE in UHRAPs, but larger, high-quality studies, with standardised reporting, are still required to determine their absolute indications for use, complication profile, efficacy and optimum design.
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Affiliation(s)
- Sarita Sochart
- Hyperacute Stroke Unit, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley, GU16 7UJ, UK
| | - Kwaku Baryeh
- Postgraduate Medical Education Department, West Middlesex University Hospital, Twickenham Road, Middlesex, TW7 6AF, UK.
| | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, Surrey, KT18 7EG, UK
- The School of Health and Society, The University of Salford, Salford, UK
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Sarkisova A, Nangeroni J. An Internal Hernia With Small Bowel Volvulus From an Inferior Vena Cava Filter Wire Strut: A Rare Cause of Acute Abdomen. Cureus 2023; 15:e45499. [PMID: 37859925 PMCID: PMC10584404 DOI: 10.7759/cureus.45499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
The use of inferior vena cava (IVC) filters has been increasingly prevalent. Although they are relatively safe with clear indications, they are not without complications. Late-onset complications include IVC filter migration, IVC wire fracture, wire strut penetration, and perforation of organs in its vicinity. In this report, we present the case of a patient with small bowel volvulus secondary to an IVC wire strut migration, causing tethering of the mesentery and vascular compromise to the small bowel.
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Affiliation(s)
- Anna Sarkisova
- General Surgery, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - James Nangeroni
- General Surgery, Southern Ocean Medical Center - Hackensack Meridian Health, Stafford, USA
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Woodward CC, Eby M, Gandhi R, Plachta SM, Baldwin K, Holderread BM, Smith HE, Arlet V, Saifi C. Do Prophylactic Inferior Vena Cava Filters Affect the Rates of Venous Thromboembolism and Pulmonary Embolism in Patients Undergoing Major Spine Surgery? Global Spine J 2023; 13:1909-1917. [PMID: 35156878 PMCID: PMC10556886 DOI: 10.1177/21925682211058462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Analysis. BACKGROUND Venous thromboembolism (VTE) represents a significant cause of morbidity and mortality in major spine surgery. Placement of prophylactic inferior vena cava filters (IVCF) in patients undergoing major spine surgery was previously adopted at our institution. This study reports our experience and compares VTE rates between patients with and without preoperative IVCF placement. METHODS A Retrospective comparative study was conducted on adult patients who underwent IVCF placement and those who did not prior to their spinal fusion procedure, between 2013 and 2016. Thoracolumbar fusions (anterior and/or posterior) of 7 or more levels, spinal osteotomies, and a minimum of a 3-month follow-up were included. Traumatic, oncologic, and cervical pathology were excluded. Primary outcomes measured included the incidence of overall VTE (DVT/PE), death, IVCF related complications, and IVCF retrieval. RESULTS 386 patients who underwent major spine surgery, 258 met the eligibility criteria. Of those patients, 105 patients (40.7%) had prophylactic IVCF placement. All patients had postoperative SCDs and chemoprophylaxis. The presence of an IVCF was associated with an increased rate of overall VTE (14.3% vs 6.5%, P ≤ .05) and DVT episodes (8.6% vs 2.6%, P = .04). The rate of PE for the IVCF group and non-IVCF group was 8.6% and 4.6%, respectively, which was not statistically significant (P = .32). The all-cause mortality rate overall of 2.3% was statistically similar between both groups (P = 1.0). The IVCF group had higher rates of hematoma/seroma vs the non-IVCF group (12.4% vs 3.9%, P ≤ .05). 99 IVCFs were retrievable designs, and 85% were successfully retrieved. Overall IVCF-related complication rate was 11%. CONCLUSIONS No statistical difference in PE or mortality rates existed between the IVCF and the control group. Patients with IVCF placement experienced approximately twice the rate of VTE and three times the rate of DVT compared to those without IVCF. The IVCF-related complication rate was 11%. Based on the results of this study, the authors recommend against the routine use of prophylactic IVCFs in adults undergoing major spine surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chase C. Woodward
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Eby
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Rikesh Gandhi
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen M. Plachta
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith Baldwin
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan M. Holderread
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Harvey E. Smith
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Arlet
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Comron Saifi
- Spine Surgery Service, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
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Olanipekun T, Ritchie C, Abe T, Effoe V, Chris-Olaiya A, Biney I, Erben YM, Guru P, Sanghavi D. Updated Trends in Inferior Vena Cava Filter Use by Indication in the United States After Food and Drug Administration Safety Warnings: A Decade Analysis From 2010 to 2019. J Endovasc Ther 2023:15266028231156089. [PMID: 36859812 DOI: 10.1177/15266028231156089] [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: 03/03/2023]
Abstract
BACKGROUND Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status. METHODS Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) "treatment" in patients with VTE diagnosis and contraindication to anticoagulation and "prophylaxis" in patients without VTE. Generalized linear regression was used to analyze utilization trends. RESULTS A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of -8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (-11.6% vs -7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of -7.9% and -10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (-17.2%) and prophylactic indications (-18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (-10.3%) and prophylactic indications (-12.5%). CONCLUSION The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions. CLINICAL IMPACT Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 - 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.
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Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN, USA
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Charles Ritchie
- Department of Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Valery Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Interventional Cardiology, Aurora Health Care, Milwaukee, WI, USA
| | - Abimbola Chris-Olaiya
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Isaac Biney
- Department of Pulmonary and Critical Care Medicine, The University of Tennessee Medical Center, Knoxville, TN, USA
| | - Young M Erben
- Department of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pramod Guru
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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11
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Sridharan N, Williams AO, Rojanasarot S, Anderson N, Wifler W, Jaff MR, Chaer R. Cost Burden and Cost Influencers of Inferior Vena Cava Filter Placement and Retrieval among Medicare Beneficiaries with Acute Venous Thromboembolism. J Vasc Interv Radiol 2023; 34:164-172.e2. [PMID: 36265817 DOI: 10.1016/j.jvir.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To examine the frequency, costs, and cost influencers of inferior vena cava filters (IVCFs) placements and retrievals among a national sample of patients using Medicare data. MATERIALS AND METHODS This retrospective cohort study used the U.S. Medicare 100% database, a nationally representative sample of all U.S. patients aged ≥65 years, from 2014 through 2020. Procedures and clinical characteristics were identified from the diagnosis and procedure codes on Medicare claims. Beneficiaries aged ≥65 years with newly diagnosed venous thromboembolism (VTE) were identified and followed to obtain data on IVCF placements and retrievals. Data on the costs of the index IVCF procedures and any subsequent IVCF placements and retrievals were obtained. Multivariate models were used to estimate the impact of patient and clinical characteristics on costs. RESULTS Among 501,216 patients with newly diagnosed VTE, 4,995 (1%) received an IVCF placement; of these, 1,215 (24.3%) had a retrieval procedure. Beneficiaries with IVCF placements and retrievals differed from a demographic and clinical perspective than from those without. Costs varied by the site of service, VTE acuity, and VTE type. Cost influencers included age, race, census region, service location, and VTE type. CONCLUSIONS IVCF placement costs were driven by baseline patient characteristics (age, race, geographic residence, acute VTE diagnosis, and inpatient site of service), whereas retrieval costs were driven by age and deep vein thrombosis diagnosis. Strategies to mitigate the retrieval costs or the need to retrieve IVCFs may reduce the overall cost burden of IVCFs.
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Affiliation(s)
| | | | | | | | | | | | - Rabih Chaer
- UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania
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12
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Yu F, Wu S, Chen C. Predictors of long-term outcomes after catheter-directed thrombolysis combined with stent implantation in acute deep vein thrombosis secondary to iliac vein compression. Medicine (Baltimore) 2023; 102:e32646. [PMID: 36705394 PMCID: PMC9875978 DOI: 10.1097/md.0000000000032646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study is to analyze predictive factors for long-term clinical outcomes after catheter-directed thrombolysis (CDT) combined with stent implantation for acute deep vein thrombosis (DVT) secondary to iliac vein compression (IVC). A retrospective analysis was performed to review clinical data and follow-up information on 52 patients who underwent CDT combined with stent implantation for acute DVT secondary to IVC from June 2015 to March 2020. Clinical outcomes including stent patency and incidence of postthrombotic syndrome (PTS) were investigated using Kaplan-Meier analysis. All included patients were categorized into 2 groups according to the presence of PTS. Potential risk factors, including age, gender, degree of iliac vein stenosis, time from onset to treatment, dosage of thrombolytic agent, stent extending below the inguinal ligament, and duration of anticoagulation for PTS were evaluated using multivariate logistic regression analysis. Over a median follow-up of 24 months, 4 individuals underwent reintervention due to in-stent stenosis or stent compression. Primary stent patency was 98.1% at 1 month, 94.2% at 6 months, 90.4% at 12 months, and 88.5% at 24 months. Freedom from PTS was 98.1% at 6 months, 84.6% at 12 months, and 75% at 24 months. No treatment-related mortality or morbidity was observed. Based on the development of PTS, 13 patients with PTS were classified into group A and 39 patients without PTS were regarded as group B. Upon multivariate logistic regression analysis, key prognostic factors for PTS were degree of iliac vein stenosis and time from onset to treatment. CDT combined with stent implantation is safe and effective for acute DVT secondary to IVC in the long-term perspective. Severe iliac vein stenosis and longer period from onset to treatment may be associated with a higher risk of PTS.
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Affiliation(s)
- Feng Yu
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
| | - Shuai Wu
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
| | - Cong Chen
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
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13
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Abstract
The use of retrievable inferior vena cava filters is on the rise, but there is an inadequate number of these filters being removed even if their use as a prophylactic for venous thromboembolism is no longer indicated. Complications with retrievable filters that remain in the patient for an extended duration include examples such as filter tilt and embedding into the caval wall. This raises concerns for whether the filter is properly functioning and for consequent sequelae, including recurrent thrombosis, stenosis, or inferior vena cava perforation. With these complications, there are also challenges to retrieving these filters via the standard techniques and thus more advanced techniques are required. Both standard and advanced techniques, their uses, and possible risks of these methods are also discussed.
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Affiliation(s)
- Chan W Kim
- From the Division of Vascular Surgery, and the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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14
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Sheahan KP, Tong E, Lee MJ. A review of inferior vena cava filters. Br J Radiol 2023; 96:20211125. [PMID: 35856774 PMCID: PMC10997026 DOI: 10.1259/bjr.20211125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/20/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.
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Affiliation(s)
| | - Emma Tong
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
| | - Michael J. Lee
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
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15
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Bistervels IM, Buchmüller A, Tardy B. Inferior vena cava filters in pregnancy: Safe or sorry? Front Cardiovasc Med 2022; 9:1026002. [DOI: 10.3389/fcvm.2022.1026002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundPotential hazards of vena cava filters include migration, tilt, perforation, fracture, and in-filter thrombosis. Due to physiological changes during pregnancy, the incidence of these complications might be different in pregnant women.AimTo evaluate the use and safety of inferior vena cava filters in both women who had an inferior vena cava filter inserted during pregnancy, and in women who became pregnant with an inferior vena cava filter in situ.MethodsWe performed two searches in the literature using the keywords “vena cava filter”, “pregnancy” and “obstetrics”.ResultsThe literature search on women who had a filter inserted during pregnancy yielded 11 articles compiling data on 199 women. At least one filter complication was reported in 33/177 (19%) women and included in-filter thrombosis (n = 14), tilt (n = 6), migration (n = 5), perforation (n = 2), fracture (n = 3), misplacement (n = 1), air embolism (n = 1) and allergic reaction (n = 1). Two (1%) filter complications led to maternal deaths, of which at least one was directly associated with a filter insertion. Filter retrieval failed in 9/149 (6%) women. The search on women who became pregnant with a filter in situ resulted in data on 21 pregnancies in 14 women, of which one (6%) was complicated by uterine trauma, intraperitoneal hemorrhage and fetal death caused by perforation of the inferior vena cava filter.ConclusionThe risks of filter complications in pregnancy are comparable to the nonpregnant population, but could lead to fetal or maternal death. Therefore, only in limited situations such as extensive thrombosis with a contraindication for anticoagulants, inferior vena filters should be considered in pregnant women.
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16
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Avery MJ, Cullen NR, Lessne ML, Thomas BW, Sing RF. Safe endovascular retrieval of a vena cava filter after duodenal perforation. J Osteopath Med 2022; 122:605-608. [PMID: 36330769 DOI: 10.1515/jom-2021-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
Abstract
The use of vena cava filters (VCF) is a common procedure utilized in the prevention of pulmonary embolism (PE), yet VCFs have some significant and known complications, such as strut penetration and migration. Deep vein thrombosis (DVT) and PE remain a major cause of morbidity and mortality in the United States. It is estimated that as many as 900,000 individuals are affected by these each year with estimates suggesting that nearly 60,000–100,000 Americans die of DVT/PE each year. Currently, the preferred treatment for DVT/PE is anticoagulation. However, if there are contraindications to anticoagulation, an inferior vena cava (IVC) filter can be placed. These filters have both therapeutic and prophylactic indications. Therapeutic indications (documented thromboembolic disease) include absolute or relative contraindications to anticoagulation, complication of anticoagulation, failure of anticoagulation, propagation/progression of DVT during therapeutic anticoagulation, PE with residual DVT in patients with further risk of PE, free-floating iliofemoral IVC thrombus, and severe cardiopulmonary disease and DVT. There are also prophylactic indications (no current thromboembolic disease) for these filters. These include severe trauma without documented PE or DVT, closed head injury, spinal cord injury, multiple long bone fractures, and patients deemed at high risk of thromboembolic disease (immobilized or intensive care unit). Interruption of the IVC with filters has long been practiced and is a procedure that can be performed on an outpatient basis. There are known complications of filter placement, which include filter migration within the vena cava and into various organs, as well as filter strut fracture. This case describes a 66-year-old woman who was found to have a filter migration and techniques that were utilized to remove this filter.
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Affiliation(s)
- Michael J Avery
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Bradley W Thomas
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Ronald F Sing
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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17
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Hao JS, Li X, Lu WL, Chen Q. Clinical study of safety and efficacy of the AngioJet mechanical drug thrombectomy in the treatment of inferior vena cava thrombosis. Asian J Surg 2022; 46:2051-2052. [PMID: 36376181 DOI: 10.1016/j.asjsur.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jian-Shu Hao
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China; Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China.
| | - Xiong Li
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Wei-Long Lu
- Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, 730000, China
| | - Quan Chen
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China; Dongguan People's Hospital, Dongguan, Guangdong, 523000, China.
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18
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Ramakrishnan G, Willie-Permor D, Yei K, Nejim B, Enuma Z, Gasparis AP, Malas MB. Immediate and Delayed Complications of IVC Filters. J Vasc Surg Venous Lymphat Disord 2022; 11:587-594.e3. [PMID: 36206894 DOI: 10.1016/j.jvsv.2022.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Inferior vena cava (IVC) filter placement has increased dramatically in the past two decades. However, literature supporting the efficacy of these devices has been limited and controversial. In the present study, we have evaluated the predictors and rates of technical complications after IVC filter insertion in a large national database. METHODS The Vascular Quality Initiative registry was explored (January 2013 to December 2020). Immediate complications were defined as venous injury requiring treatment, filter misplacement (failure to open, deployed >20 mm from intended site or in wrong vein, embolized to the heart), angulation >20°, and insertion site complications. Delayed complications were defined as migration, angulation >15°, fracture, caval and/or iliac thrombosis, filter thrombus, fragment embolization, and perforation. The Pearson χ2 test was used to compare the baseline characteristics between the patients who had developed immediate and/or delayed complications and those who had not. The predictors of these complications were evaluated using multivariable logistic regression, Cox proportional hazard regression, and Kaplan-Meier survival analysis. RESULTS A total of 14,784 patients were included in the present analysis, with a median follow-up of 11 months (interquartile range, 4-16 months). The rate of immediate and delayed complications was 1.8% and 3.1%, respectively. Angulation (1.2%) was the most common immediate complication, and filter thrombosis (1.6%) was the most common delayed complication. Compared with the patients with no immediate complications, those with immediate complications were more likely to have had abnormal anatomy (6.0% vs 1.7%; P < .001) and a landing zone other than infrarenal (7.0% vs 4.2%; P = .02). Compared with their counterparts, those with delayed complications were less likely to have received statins (21.0% vs 29.5%; P = .006) and were more likely to have a family history of venous thromboembolism (8.0% vs 5.1%; P = .047). Logistic regression analysis revealed that renal vein visualization was associated a 50% reduction (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.27-0.92; P = .027) in the odds of immediate complications and female sex and abnormal anatomy were associated with a 41% (aOR, 1.41; 95% CI, 1.08-1.85; P = .013) and 244% (aOR, 3.44; 95% CI, 1.66-7.16; P < .001) increase in the odds of immediate complications, respectively. Immediate (P = .21) and delayed (P = .51) complications did not result in increased mortality. CONCLUSIONS The immediate and delayed IVC filter complication rates were 1.8% and 3.1%, respectively, but the occurrence of complications was not associated with increased mortality. Female sex was associated with an increase in the development of immediate complications. The incidence of immediate complications might be mitigated if advanced imaging were used for renal vein visualization before IVC filter deployment. Delayed complications might be avoided if IVC filter retrieval were performed in a timely fashion and institutional retrieval protocols were optimized.
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Ikesaka R, Kaur B, Crowther M, Rajasekhar A. Efficacy and safety of pre-operative insertion of inferior vena cava filter in patients undergoing bariatric surgery: a systematic review. J Thromb Thrombolysis 2022; 54:502-523. [PMID: 35960423 DOI: 10.1007/s11239-022-02689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
Prophylactic placement of inferior vena cava (IVC) filters prior to performing bariatric surgery is an intervention of unclear safety and efficacy with disagreement between current practice guidelines. To better characterize the risk and benefit of IVC filter insertion prior to bariatric surgery based on the current evidence. A systematic review of the literature of patients with prophylactic IVC filter insertion prior to bariatric surgery was performed and 32 studies were identified for inclusion into the review, of which none were randomized controlled trials. Meta-analysis was performed including the high-quality included studies. Seven high quality studies reported thrombotic events in patients undergoing bariatric surgery who had an IVCF and a control group which allowed for meta-analysis. The pooled odds ratio of venous thrombotic events in the IVC filter population versus the group without IVC filters was 1.57 (95%CI 0.89, 2.76). Among high quality studies 5 reported major bleeding with a rate of 0.76% and 6 reported on IVC filter complications with a rate of 0.67%. Overall no significant reduction in the rate of venous thrombosis was found with prophylactic IVC filter insertion. Use of IVC filters for prophylaxis remains a concern given the lack of clear efficacy in this setting and a small but present complication risk.
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Affiliation(s)
| | - Bhagwanpreet Kaur
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | | | - Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
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Lee SJ, Fan S, Guo M, Majdalany BS, Newsome J, Duszak R, Gichoya J, Benjamin ER, Kokabi N. Prophylactic IVC filter placement in patients with severe intracranial, spinal cord, and orthopedic injuries at high thromboembolic event risk: A utilization and outcomes analysis of the National Trauma Data Bank. Clin Imaging 2022; 91:134-140. [DOI: 10.1016/j.clinimag.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
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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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22
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Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism. J Clin Med 2021; 11:jcm11010077. [PMID: 35011826 PMCID: PMC8745208 DOI: 10.3390/jcm11010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). Methods: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. Results: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. Conclusion: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines.
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Contemporary Rates of Inferior Vena Cava Filter Thrombosis and Risk Factors. J Vasc Surg Venous Lymphat Disord 2021; 10:313-324. [PMID: 34425266 DOI: 10.1016/j.jvsv.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Inferior vena cava thrombosis is an uncommon complication associated with inferior vena cava filters (IVCF), with literature citing rates ranging from 1% to 31%. Few observational studies describe risk factors associated with IVCF thrombosis, despite the significant clinical sequelae such as post-thrombotic syndrome, venous claudication, and venous ulceration. To better describe IVCF thrombosis and risk factors, data were queried from VQI-participating centers. METHODS IVCF data were obtained through the international VQI database from 2013 - 2019. Patients included in this analysis had two-year follow-up. Baseline demographics, medical comorbidities, medication, procedural, anatomical, and post-operative variables were assessed using Kaplan-Meier survival curves with log-rank tests, Student's t-tests, or Mann-Whitney U tests for IVCF thrombosis at two years. Cox regression analyses identified independent predictors of IVCF thrombosis. A subgroup analysis of those who presented with a venous thromboembolism (VTE) was also performed. RESULTS There were 62 US and Canadian VQI-participating centers, including 12,874 cases of IVCF placement. There 78 cases (1.3%) of IVCF thrombosis identified out of a total of 5,780 cases with two-year follow up. Those who experienced IVCF thrombosis had significantly lower rates of diabetes, coronary artery disease, pre-operative antiplatelet medications, pre-operative statins, as well as lower rates of discharge and follow up antiplatelet medications. On univariable analysis, cases of IVCF thrombosis also had higher rates of pulmonary emboli (PE) and VTE on admission, internal jugular venous access (versus femoral vein access), temporary IVCF use, follow up anticoagulation, follow up IVCF complication, follow up access site thrombosis, and rates of new or propagated DVT at follow up, and longer post-operative hospital stays. Multivariable analysis demonstrated independent predictors of IVCF thrombosis included new or propagated DVT at follow up (hazard ratio [HR]=16.3, 95% confident interval (CI) = 9.8 - 27.3, P<.001), no antiplatelet at follow up (HR=4.8, 95% CI= 1.9 - 12.5, P=.001), internal jugular venous access (HR=2.2, 95% CI=1.4 - 3.5, P=.001), VTE on admission (HR=2.7, 95% CI=1.4 - 5.1, P=.002), and temporary IVCF placement (HR=2.5, 95% CI = 1.1 - 5.6, P=.031). In an analysis of the subgroup of patients with VTE on admission, similar predictive factors were identified in a multivariable model, in addition, massive PE was also predictive of IVCF thrombosis in this subgroup. CONCLUSION The rate of IVCF thrombosis remained low in a contemporary international database. This study of over 5,000 patients with IVCFs suggests that antiplatelet therapy should be administered after IVCF placement to decreased risk of IVCF thrombosis.
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Huang CR, Pan S, Li Z, Ruan RX, Jin WY, Zhang XC, Pang Y, Guo KJ, Zheng X. Tourniquet use in primary total knee arthroplasty is associated with a hypercoagulable status: a prospective thromboelastography trial. INTERNATIONAL ORTHOPAEDICS 2021; 45:3091-3100. [PMID: 34191090 DOI: 10.1007/s00264-021-05126-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN Prospective study. PURPOSE The main purpose of this study was to investigate whether the use of a tourniquet changes the blood coagulation state following primary total knee arthroplasty (TKA) by means of conventional coagulation tests and thromboelastography (TEG) analyses. METHODS A total of 154 patients who underwent primary unilateral TKA from January 2018 to October 2020 were enrolled. Seventy-nine patients were randomized into a tourniquet group, and 75 were randomized into a no-tourniquet group. Demographic data, surgical time, intra-operative blood loss, transfusion rate, and wound complications were collected. Complete blood count, conventional coagulation tests, and TEG were performed the day before surgery, one day after surgery, three days after surgery, and seven days after surgery. Lower extremity Doppler ultrasound was performed the day before surgery and seven days after surgery. RESULTS The baseline characteristics of the patients were similar between the two groups. Hidden blood loss, transfusion rate, and wound complications were similar between the two groups, but the intra-operative blood loss of the tourniquet group was lower than that of the no-tourniquet group. The calculated total blood loss of the tourniquet group was higher than that of the no-tourniquet group. In terms of conventional coagulation tests and TEG, the tourniquet group had higher values of fibrin degradation products, D-dimer, maximum amplitude, and coagulation index (p < 0.001). The incidence of deep vein thrombosis (DVT) in the tourniquet group was higher than that in the no-tourniquet group (21.5% compared with 8%; p = 0.019). CONCLUSION The application of a tourniquet during TKA significantly increases the amount of calculated total blood loss and does not decrease the post-operative transfusion rate. Using a tourniquet in routine TKA exacerbates the early post-operative hypercoagulable status together with a higher incidence of below-knee asymptomatic DVT observed via conventional coagulation tests, TEG, and ultrasonic Doppler.
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Affiliation(s)
- Chao-Ran Huang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Sheng Pan
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Zheng Li
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Ru-Xin Ruan
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Wang-Yi Jin
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Xing-Chen Zhang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Yong Pang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China
| | - Kai-Jin Guo
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China.
| | - Xin Zheng
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road West, Xuzhou, 221006, People's Republic of China. .,Department of Orthopaedics, Zhujiang Hospital of Southern Medical University, 253 Gongye Avenue, Guangzhou, 510282, People's Republic of China.
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Pillai A, Kathuria M, Bayona Molano MDP, Sutphin P, Kalva SP. An expert spotlight on inferior vena cava filters. Expert Rev Hematol 2021; 14:593-605. [PMID: 34139952 DOI: 10.1080/17474086.2021.1943350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Inferior vena cava (IVC) filters are mechanical filtration devices designed as an alternative to surgical ligation/plication of the IVC. Their use has been controversial, especially with the introduction of retrievable filters and expanded/prophylactic indications.Areas covered: Authors discuss the types of available IVC filters, indications for placement, evidence on their effectiveness in general and specific patient populations, procedural considerations, off-label use, complications, and filter retrieval. This review is based on manuscripts/abstracts published from 1960 to 2021 on venous thromboembolism and IVC filters.Expert opinion: Despite the limited data on their effectiveness and survival benefit, IVC filters continue to play an important role in the treatment of patients with venous thromboembolism (VTE) who cannot receive standard anticoagulation. There is no role of IVC filters in patients without VTE. While retrievable filters are desirable for short-term use, a dedicated team-based approach, and advanced training are required for their successful removal. Newer devices are promising in improving patient safety . The device manufacturers and regulatory agencies should consider specific approaches to track device-related adverse events. Population-based studies are required to establish optimal patient population who would benefit from these devices. .
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Affiliation(s)
- Anil Pillai
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manoj Kathuria
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Patrick Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Huang J, Dai X, Zhang X, Li J, Huang M, Liu C, Zhao Z, Xiao L, Liu L, Li N, Kong J, Han X. Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience. J Int Med Res 2021; 49:3000605211006591. [PMID: 33845601 PMCID: PMC8047091 DOI: 10.1177/03000605211006591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery. Methods Clinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups. Results An IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups. Conclusions Retrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.
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Affiliation(s)
- Junjie Huang
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China.,Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Xiangchen Dai
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Xiujun Zhang
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Junhai Li
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Mei Huang
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Cunfa Liu
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Ziyuan Zhao
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Lei Xiao
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Liguo Liu
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Nan Li
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Jingbo Kong
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
| | - Xiaolei Han
- Department of Vascular Surgery, Tianjin Hospital, Tianjin, P.R. China
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27
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Ladd M, Lullo D, Abadin S. Preferential central venous catheter access with concurrent IVC filter use. J Vasc Access 2021; 23:959-961. [PMID: 33971760 DOI: 10.1177/11297298211015073] [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: 11/16/2022] Open
Abstract
In our aging population, there is an increased incidence of concurrent IVC filter and central venous catheter use. One of the risks of concurrent use is filter embolization, which almost always occurs due to the J-tipped guidewire. In this case, we describe the successful placement of a central venous catheter in the femoral vein in a patient with an IVC filter. Some guidelines exist concerning CVC placement in patients with IVC filters, and this case highlights the benefits of placing a CVC in the femoral vein. While little research exists regarding higher rates of IVC filter embolization in internal jugular and subclavian vein access sites, we hypothesize it is due to the conical shape of IVC filters.
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Affiliation(s)
- Megan Ladd
- AMITA Health, General Surgery, Chicago, IL, USA
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Kim M, Lee SY, Cha JG, Hong J, Lim KH, Lee J, Cha SI, Kim CH, Kim HK, Oh CW. Single center experience of inferior vena cava filter retrieval in trauma patients: contrast-enhanced CT-based retrieval within hospital stay. Clin Imaging 2021; 79:43-47. [PMID: 33872915 DOI: 10.1016/j.clinimag.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the safety and retrieval rate of a predischarge inferior vena cava (IVC) filter retrieval strategy based on contrast computed tomography (CT). METHODS IVC filter insertion for trauma patients from 2010 to 2018 were reviewed. An active filter retrieval strategy was established in March 2017. The strategy sought early evaluation of venous thromboembolism (VTE) status and filter retrieval before a patient's discharge. The possibility of early IVC filter retrieval was evaluated by a multidisciplinary team based on pre-filter retrieval VTE-CT findings. Overall VTE-CT findings, retrieval rate, indwelling time, and recurrence of venous thromboembolic events were compared before and after the filter retrieval strategy setup. RESULTS 177 IVC filters were inserted in trauma patients. All patients underwent pre-filter retrieval VTE-CT. VTE-CT findings were as follows: completely resolved VTE, n = 108 (61%); partially improved, n = 58 (33%); no change, n = 8 (5%); aggravated, n = 3 (2%). The overall retrieval rate was 84% with a mean indwelling time of 32 days. In subgroup analyses, 95 (53%) had filter retrieval with the before strategy (BS) setup and 82 (47%) with the after strategy (AS) setup. The retrieval rate was significantly higher in the AS group [81/82 (99%) vs. 68/95 (72%), (p < 0.001)]. No patients had recurrent VTE during the follow-up period. CONCLUSIONS The active strategy of VTE-CT-based filter retrieval during the hospital stay markedly improved the filter retrieval rate from 72% to 99% without evidence of recurrence of VTE. Hazards of low retrieval rate versus CT-related radiation exposure should be studied in the future.
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Affiliation(s)
- Miran Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kyoung Hoon Lim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Hyung-Kee Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
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Structured team-oriented program to follow patients after vena cava filter placement: a step forward in improving quality for filter retrieval. Sci Rep 2021; 11:3526. [PMID: 33568732 PMCID: PMC7875966 DOI: 10.1038/s41598-021-82767-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. Nevertheless, IVCF retrieval rates remain lower than expected, likely due to insufficient follow-up after placement. We evaluated the value of a structured program designed to follow patients by the interventional radiology team up to 5 months after IVCF placement. We prospectively enrolled 366 consecutive patients (mean age 64 ± 17 years; 201 men and 165 women) who benefited from IVCF between March 2015 and February 2020. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Clinical and technical eligibility, as well as technical success for retrieval (TSR) were evaluated. At 5-months, 38 (10.4%) patients were lost to follow-up, and 47 (12.8%) had died. Among survivors, the overall retrieval rate was 58%. The retrieval rates were 83% and 97% for the clinically eligible and technically eligible patients for retrieval, respectively. The 5-month visit enabled 89 additional retrievals (47.8%) compared to the standard workflow. No significant difference was seen in TSR before and after 5 months (p = 0.95). Improved patient tracking with a dedicated IVCF program results in an effective process to identify suitable patients for retrieval and drastically improves retrieval rates in eligible patients. Involving interventionalists in the process improved IVCF patient management.
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Ionescu F, Anusim N, Ma E, Qu L, Blankenship LM, Stender M, Jaiyesimi I. Inferior Vena Cava Filter Retrieval Trends: A Single-Center Experience. TH OPEN 2021; 5:e73-e80. [PMID: 33585788 PMCID: PMC7875678 DOI: 10.1055/s-0040-1722707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/10/2020] [Indexed: 12/04/2022] Open
Abstract
Recognition of the adverse events of inferior vena cava filters (VCFs) has prompted the Food and Drug Administration (FDA) to issue safety warnings (2010 and 2014), advocating for removal, once the risk of pulmonary embolism has abated. Despite an initial increase in retrieval rates, these remain low (25–30% at 1 year in 2014). We retrospectively investigated retrieval trends in adults with VCFs placed between 2015 and 2018 at a single institution. The rate of retrievable VCF removal accounting for the competing risk of death was the main outcome. There were 494 VCFs placed (305 retrievable). The cumulative incidence of retrieval remained low (21% at 1 year), even after the second FDA warning (2014). Patients who resumed anticoagulation (AC) at any time were more likely to have retrieval (hazard ratio [HR] = 3.6,
p
< 0.01) and had higher retrieval rates at every time point (31.4 vs. 7.6% at 1 year). Advanced age (HR = 0.98 per year,
p
= 0.004), stroke (HR = 0.28,
p
= 0.028), and active malignancy (HR = 0.42,
p
= 0.006) predicted nonretrieval. Device-related complications were infrequent (<1%) but thrombotic complications occurred early and were more common for nonretrieved VCFs (17 vs. 12%,
p
= 0.29). Revision of guidelines to recommend active surveillance for the ability to tolerate AC in the immediate postimplantation period may improve retrieval rates.
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Affiliation(s)
- Filip Ionescu
- Department of Internal Medicine, Beaumont Health System, Royal Oak, Michigan, United States
| | - Nwabundo Anusim
- Department of Hematology-Oncology, Beaumont Health System, Royal Oak, Michigan, United States
| | - Eva Ma
- Department of Internal Medicine, Beaumont Health System, Royal Oak, Michigan, United States
| | - Lihua Qu
- Beaumont Health Research Institute, Royal Oak, Michigan, United States
| | - LeAnn M Blankenship
- Department of Hematology-Oncology, Beaumont Health System, Royal Oak, Michigan, United States
| | - Michael Stender
- Department of Hematology-Oncology, Beaumont Health System, Royal Oak, Michigan, United States
| | - Ishmael Jaiyesimi
- Department of Hematology-Oncology, Beaumont Health System, Royal Oak, Michigan, United States
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Role of Inferior Vena Cava Filter Retrieval in Patients on Chronic Anticoagulation Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractPurpose of reviewDescribe the role of inferior vena cava filter (IVCF) retrieval in patients on chronic anticoagulation given the overlap of these treatment options in the management of patients with venous thromboembolic disease.Recent findingsDespite the increase in IVCF retrievals since the Food and Drug Administration safety communications in 2010 and 2014, retrieval rates remain low. Previous studies have shown that longer filter dwell times are associated with greater risk for filter complications and more difficulty with filter retrievals. Recent findings suggest that complications are more frequent in the first 30 days after placement.SummaryThe decision to retrieve an optional IVCF is individualized and requires diligent follow-up with consistent re-evaluation of the need for the indwelling IVCF, particularly in those on long-term anticoagulation therapy.
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Ganga KP, Vadher A, Ojha V, Goyal A, Kumar S. IVC filters - Indications for placement and retrieval trends- experience from a tertiary referral centre in India type of submission- full paper. Indian Heart J 2021; 73:331-335. [PMID: 34154751 PMCID: PMC8322748 DOI: 10.1016/j.ihj.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives There is wide variation in the practice of IVC filter placement and retrievals. We conducted a retrospective study to identify the trends in placement and retrievals of IVC filters in a tertiary referral centre in India. Methods The data of patients obtained from our hospital records, in whom IVC filter was placed between 2010 and 2018, were analysed for demographics, indications for placement of IVC filter, underlying comorbidities, characteristics of the filters as well as the retrieval rates. Results IVC filters were placed in 50 patients, and data was retrieved for 31 patients (mean - 51.24 years, 67.74% males). According to ACCP/AHA guidelines, 24 (77.42%) had an absolute indication for IVC filter. All 31 IVC filters were temporary, 23 (74.19%) of which were placed via femoral access. 29(93.55%) patients had infrarenal IVC filter placement. The average tilt at deployment was 3.71°, whereas it was 5.3° at retrieval. There were no periprocedural complications or filter migrations during placement or retrieval. Retrieval was attempted in 11 (35.48%) patients and was successful in 10. The mean indwelling time in this group was 158.55 days (range 55–366 days). Conclusion Our study reveals low IVC filter implantation rates which are predominantly for absolute rather than relative indications. Though in sync with the worldwide trend, the poor retrieval rates reflect the urgent need for better patient and physician awareness. Periodic follow up is imperative to improve the IVC filter retrieval rate and to prevent complication rates.
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Affiliation(s)
- Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Akash Vadher
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aayush Goyal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Arslanbekov MM, Efremova OI, Lebedev IS, Kirienko AI, Zolotukhin IA. Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital. Phlebology 2020; 36:450-455. [PMID: 33308030 DOI: 10.1177/0268355520975582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. METHODS We performed a retrospective analysis of database of a tertiary hospital in 2016-2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. RESULTS 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients' anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. CONCLUSIONS Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.
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Affiliation(s)
- Magomed M Arslanbekov
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Oksana I Efremova
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Igor S Lebedev
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Aleksandr I Kirienko
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Igor A Zolotukhin
- University Surgery Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
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Lun EWY, Giordano NJ, Kramer A, Mortensen CS, Torrey J, Zheng H, Kabrhel C. Patient and operational factors that influence the decision to place an inferior vena cava filter in a pulmonary embolism response team. J Vasc Surg Venous Lymphat Disord 2020; 9:895-903. [PMID: 33278645 DOI: 10.1016/j.jvsv.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The use of inferior vena cava (IVC) filters is controversial. However, the procedure is widely performed for secondary prophylaxis in patients with severe pulmonary embolism (PE), including those treated by a PE response team (PERT). In this study, we analyzed patient factors associated with the clinical decision to place an IVC filter in PERT patients. METHODS Data were collected on all Massachusetts General Hospital patients who had a PERT activation from October 1, 2012, to January 29, 2019. Data describing demographics, medical history, PE characteristics and treatment were collected at the time of PERT activation and prospectively for one year after PERT activation. Univariate and multivariable regression analyses were performed to determine factors associated with IVC filter placement. RESULTS We identified 834 patients, of whom 91 (10.9%) had an IVC filter placed in the first 7 days after PERT activation. The majority of patients receiving an IVC filter were male (55/91 [60.4%]; P =.096) with a mean age of 65 ± 15.0 years. Patients who received an IVC filter were less likely to have had a PERT referral from the Emergency Department (ED) (41/544 [7.5%]; P < .001) and more likely to have been referred from the intensive care unit (24/107 [22.43%]; P ≤ .001) compared with a floor referral. Patients who presented with syncope (15/86 [17.4%]; P = .040), a history of recent trauma (12/41 [29.3%]; P < .001), intracranial hemorrhage (11/39 [28.2%]; P = .002), a recent surgery or invasive procedure (30/188 [16.0%]; P = .012), a recent surgery (29/160 [18.1%]; P = .001) and a recent hospitalization (38/250 [15.2%]; P = .009) were more likely to have an IVC filter placed. Patients receiving an IVC filter were also more likely to have evidence of right heart dysfunction on a computed tomography pulmonary angiogram (61/359 [17.0%]; P < .001) and an echocardiogram (26/144 [18.1%]; P = .003). Compared with patients without an IVC filter, the 30-day venous thromboembolism recurrence rate was higher (4.7% vs 11.0%) in patients with IVC filters (10/45 [22.2%]; P = .023). CONCLUSIONS Factors associated with venous thromboembolism severity (eg, PERT referral from intensive care unit and right ventricular dysfunction) and an increased bleeding risk (eg, recent surgery or trauma) were associated with IVC filter placement among PERT patients.
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Affiliation(s)
- Elizabeth Weng Yan Lun
- Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | | | - Anders Kramer
- Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Schmidt Mortensen
- Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jasmine Torrey
- Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Hui Zheng
- Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Christopher Kabrhel
- Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Takase T, Iwanaga Y, Yamashita Y, Morimoto T, Yoshikawa Y, Amano H, Hiramori S, Kim K, Oi M, Kobayashi Y, Nishimoto Y, Watanabe H, Yamaji K, Yasuoka R, Ueno M, Kobuke K, Kimura T, Miyazaki S. Long-term effects of non-retrieved inferior vena cava filters on recurrences of venous thromboembolism in cancer and non-cancer patients: From the COMMAND VTE registry. Eur J Intern Med 2020; 82:S0953-6205(20)30347-2. [PMID: 32921533 DOI: 10.1016/j.ejim.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/08/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a paucity of data comparing the long-term outcomes after inferior vena cava (IVC) filters placement for patients with acute venous thromboembolism (VTE) between those with and without active cancer. METHODS In the COMMAND VTE Registry, we evaluated the effects of IVC filter use on the long-term clinical outcomes stratified by the presence and absence of active cancer. RESULTS Among 2,626 patients with acute symptomatic VTE, there were 604 patients with active cancer, and 2022 patients without active cancer. IVC filters were placed and not retrieved in 455 patients (17%) in the entire cohort, in 150 patients (24.8%) in the active cancer stratum, and in 305 patients (15.1%) in the non-cancer stratum. In the entire cohort, non-retrieved IVC filter placement was not associated with a lower adjusted risk for PE recurrence (HR 0.59, 95% CI 0.30-1.15, P = 0.122), but with an increased adjusted risk for DVT recurrence (HR 2.27, 95% CI 1.43-3.60, P<0.001). In the non-cancer stratum, the non-retrieved IVC filter placement was associated with a decreased risk for PE (HR 0.29, 95% CI 0.09-0.93, P = 0.037), but not with an increased risk for DVT (HR 1.73, 95% CI 0.89-3.38, P = 0.108), while in the active cancer stratum, it was associated with an increased risk for DVT (HR 2.47, 95% CI 1.24-4.91, P = 0.010), but not with a decreased risk for PE (HR 0.82, 95% CI 0.34--1.96, P = 0.650). CONCLUSIONS There were some differences in the risk-benefit balance between VTE patients with and without active cancer.
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Affiliation(s)
- Toru Takase
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan.
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidewo Amano
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Heitaro Watanabe
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kenji Yamaji
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Ryobun Yasuoka
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masafumi Ueno
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kazuhiro Kobuke
- Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Morris JC, O’Connor MI. Anticoagulation Management in Geriatric Orthopedic Trauma Patients. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Layfield EM, Stavropoulos SW, Chittams J, Quinn R, Trerotola SO. Prevalence and Characterization of Interaction of Retrievable Inferior Vena Cava Filters with the Spine in Patients Undergoing Complex Filter Removal. J Vasc Interv Radiol 2020; 31:2073-2080. [PMID: 33189540 DOI: 10.1016/j.jvir.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine spinal interaction types and prevalence of inferior vena cava (IVC) filters in patients presenting for complex filter removal. MATERIALS AND METHODS The records of 447 patients presenting for complex removal of IVC filters were reviewed, including patient demographics, IVC filter dwell time, filter fracture status, and computed tomography (CT) evidence of filter interaction with the spine. Spinal interaction was defined as a filter strut touching or penetrating into the vertebral body or disc. Patients with evidence of filter penetration and spinal interaction had abdominal CT that preceded filter removal assessed by 2 interventional radiologists to categorize the type of spinal interaction, including bony reaction and osteophyte formation. RESULTS CT evidence of spinal interaction by the filter was found in 18% of patients (80/447). Interaction with the spine was more common in single point of fixation filters than filters with rails (P = .007) and was more likely in filters with round wires than flat wires (P = .0007). Patients with interaction had longer dwell times (mean [SD] 5.7 [4.46] y) compared with patients without interaction (mean [SD] 3.2 [3.85] y); this relationship was significant (P < .0001). Women were more likely than men to experience filter/spine interaction (P = .04). Filters with spinal interaction were more likely to be fractured (P = .001). Filter interaction was found in 38% (30/78) of patients with symptoms, including chest and back pain, compared with 14% (50/369) of patients without symptoms (P < .0001, odds ratio 3.99). CONCLUSIONS Retrievable IVC filters may interact with the spine. These interactions are associated with longer filter dwell times, female sex, and round wire filter construction.
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Affiliation(s)
- Eleanor M Layfield
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jesse Chittams
- Biostatistics Consulting, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan Quinn
- Biostatistics Consulting, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Endovascular Rescue of Sheath Perforation During Inferior Vena Cava Filter Retrieval. EJVES Vasc Forum 2020; 49:40-44. [PMID: 33345254 PMCID: PMC7736903 DOI: 10.1016/j.ejvsvf.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/18/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Inferior vena cava (IVC) filter retrieval is generally a straightforward procedure but can be challenging with unique complications. A technique used for endovascular rescue of a patient where sheath perforation by the IVC filter occurred during IVC filter retrieval is described. Report A 75 year old man underwent retrieval of an IVC filter that had been in place for 10 months. Using the IVC filter retrieval set from a standard right internal jugular vein approach and the loop-snare technique, the hook and collet were captured, and the filter was collapsed into the retrieval sheath. Approximately halfway through removal of the filter through the sheath, mild resistance was encountered and the tip of the IVC filter was found to have perforated the side of the retrieval sheath. The sheath appeared to have bent slightly in this region, probably weakening the sheath wall and creating angulation, which allowed sheath perforation to occur. From a right common femoral vein approach, an Amplatz wire was used to cannulate the distal end of the perforated sheath. A balloon was then used to pull the perforated sheath with the IVC filter into a larger sheath. After removing the Tuohy-Borst and Luer adapters on the perforated sheath, it was able to be internalised and removed via the femoral vein sheath. Discussion The endovascular rescue technique described herein may prove useful to other practitioners encountering similar situations, and the complication shows areas of caution when using the loop-snare retrieval technique.
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Beer D, Harjai K, Bauch TD, Vijayaraman P. Percutaneous Extraction of an Embolized IVC Filter Strut Embedded in the Right Ventricle. JACC Case Rep 2020; 2:2318-2322. [PMID: 34317163 PMCID: PMC8304553 DOI: 10.1016/j.jaccas.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Abstract
The incidence of IVC filter fracture is high with risk for embolization and may require open surgery. We present a minimally invasive approach of complex transcatheter extraction of an embolized and embedded IVC filter strut from the right ventricle. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | | | | | - Pugazhendhi Vijayaraman
- Address for correspondence: Dr. Pugazhendhi Vijayaraman, Cardiac Electrophysiology, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 East Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711, USA.
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40
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Li X, Haddadin I, McLennan G, Farivar B, Staub D, Beck A, Thompson D, Partovi S. Inferior vena cava filter – comprehensive overview of current indications, techniques, complications and retrieval rates. VASA 2020; 49:449-462. [DOI: 10.1024/0301-1526/a000887] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Summary: Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Ihab Haddadin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Gordon McLennan
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Behzad Farivar
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Staub
- Department of Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Avi Beck
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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May JE, Irelan PC, Boedeker K, Cahill E, Fein S, Garcia DA, Hicks LK, Lawson J, Lim MY, Morton CT, Rajasekhar A, Shanbhag S, Zumberg MS, Plovnick RM, Connell NT. Systems-based hematology: highlighting successes and next steps. Blood Adv 2020; 4:4574-4583. [PMID: 32960959 PMCID: PMC7509880 DOI: 10.1182/bloodadvances.2020002947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022] Open
Abstract
Systems-based hematology is dedicated to improving care delivery for patients with blood disorders. First defined by the American Society of Hematology in 2015, the idea of a systems-based hematologist arose from evolving pressures in the health care system and increasing recognition of opportunities to optimize the quality and cost effectiveness of hematologic care. In this review, we begin with a proposed framework to formalize the discussion of the range of initiatives within systems-based hematology. Classification by 2 criteria, project scope and method of intervention, facilitates comparison between initiatives and supports dialogue for future efforts. Next, we present published examples of successful systems-based initiatives in the field of hematology, including efforts to improve stewardship in the diagnosis and management of complex hematologic disorders (eg, heparin-induced thrombocytopenia and thrombophilias), the development of programs to promote appropriate use of hematologic therapies (eg, blood products, inferior vena cava filters, and anticoagulation), changes in care delivery infrastructure to improve access to hematologic expertise (eg, electronic consultation and disorder-specific care pathways), and others. The range of projects illustrates the broad potential for interventions and highlights different metrics used to quantify improvements in care delivery. We conclude with a discussion about future directions for the field of systems-based hematology, including extension to malignant disorders and the need to define, expand, and support career pathways.
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Affiliation(s)
- Jori E May
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - David A Garcia
- Division of Hematology, University of Washington, Seattle, WA
| | - Lisa K Hicks
- Division of Hematology/Oncology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Ming Y Lim
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, UT
| | - Colleen T Morton
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Anita Rajasekhar
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Satish Shanbhag
- Cancer Specialists of North Florida, Fleming Island, FL; and
| | - Marc S Zumberg
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | | | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Kaufman JA, Barnes GD, Chaer RA, Cuschieri J, Eberhardt RT, Johnson MS, Kuo WT, Murin S, Patel S, Rajasekhar A, Weinberg I, Gillespie DL. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol 2020; 31:1529-1544. [PMID: 32919823 DOI: 10.1016/j.jvir.2020.06.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease. MATERIALS AND METHODS A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations. RESULTS The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations. CONCLUSIONS Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.
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Affiliation(s)
- John A Kaufman
- Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon.
| | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania
| | - Joseph Cuschieri
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Robert T Eberhardt
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew S Johnson
- Department of Radiology, Indiana University School of Medicine, Indiana University Health, Indianapolis, Indiana
| | - William T Kuo
- Division of Vascular and Interventional Radiology, Stanford University School of Medicine, Stanford, California
| | - Susan Murin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Anita Rajasekhar
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - David L Gillespie
- Southcoast Vascular and Endovascular Surgery, Southcoast Physicians Group, Dartmouth, Massachusetts
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Parsi K, van Rij AM, Meissner MH, Davies AH, Maeseneer MD, Gloviczki P, Benson S, Bottini O, Canata VM, Dinnen P, Gasparis A, Gianesini S, Huber D, Jenkins D, Lal BK, Kabnick L, Lim A, Marston W, Granados AM, Morrison N, Nicolaides A, Paraskevas P, Patel M, Roberts S, Rogan C, Schul MW, Komlos P, Stirling A, Thibault S, Varghese R, Welch HJ, Wittens CHA. Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS) : A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI) This consensus document has been co-published in Phlebology [DOI: 10.1177/0268355520930884] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.05.002]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/). Phlebology 2020; 35:550-555. [PMID: 32639862 PMCID: PMC7441329 DOI: 10.1177/0268355520930884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology
(UIP)
- Australasian College of Phlebology
(ACP)
| | | | - Mark H Meissner
- International Union of Phlebology
(UIP)
- American Venous Forum (AVF)
- American Vein and Lymphatic Society
(AVLS)
| | - Alun H Davies
- Imperial College London, Charing
Cross and St Mary’s Hospital, London, UK
| | | | - Peter Gloviczki
- Division of Vascular and
Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | | | | - Adrian Lim
- Australasian College of Phlebology
(ACP)
| | | | | | - Nick Morrison
- International Union of Phlebology
(UIP)
- American Vein and Lymphatic Society
(AVLS)
| | | | | | | | | | - Christopher Rogan
- Australasian College of Phlebology
(ACP)
- Interventional Radiology Society
of Australasia (IRSA)
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Elmassry M, Del Rio-Pertuz G, El-Nawaa S, Abdelmalek J, Ansari MM. A Fractured Inferior Vena Cava Strut Migrating to the Right Ventricle Without Any Cardiovascular Complaint: A Case Report and Review of Literature. Cureus 2020; 12:e9779. [PMID: 32953297 PMCID: PMC7491686 DOI: 10.7759/cureus.9779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of inferior vena cava filter (IVCF) as one of the last resorts for pulmonary embolism prevention has expanded over the decades. The migration of a broken strut to the right ventricle is a very unusual complication that, when present, has been associated with life-threatening events. We report a case of a 34-year-old female with an inferior vena cava (IVC) strut that migrated and was incidentally found embedded in the right ventricle without any cardiovascular signs or symptoms. This case provides evidence that such filters probably have higher rates of complications than what has been thought because those complications might remain asymptomatic.
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Affiliation(s)
- Mohamed Elmassry
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Saif El-Nawaa
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - John Abdelmalek
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Mohammad M Ansari
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
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45
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Marron RM, Rali P, Hountras P, Bull TM. Inferior Vena Cava Filters: Past, Present, and Future. Chest 2020; 158:2579-2589. [PMID: 32795479 DOI: 10.1016/j.chest.2020.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Abstract
Inferior vena cava (IVC) filters have existed as a treatment option for VTE for decades. Advances in medical technology have provided physicians with several options for devices that can be placed on either a permanent or temporary basis; however, there are limited data from randomized, controlled trials on the appropriate use of IVC filters. This contemporary review summarizes the history of IVC filters and the types that are available in clinical practice. It reviews the literature on the use of IVC filters and discusses the indications that professional societies have endorsed for their use. In addition, it outlines the complications of IVC filter placement and future research directions.
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Affiliation(s)
- Robert M Marron
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Peter Hountras
- Division of Pulmonary Sciences and Critical Care, University of Colorado School of Medicine, Aurora, CO
| | - Todd M Bull
- Division of Pulmonary Sciences and Critical Care, University of Colorado School of Medicine, Aurora, CO
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Balabhadra S, Kuban JD, Lee S, Yevich S, Metwalli Z, McCarthy CJ, Huang SY, Tam A, Gupta S, Sheth SA, Sheth RA. Association of Inferior Vena Cava Filter Placement With Rates of Pulmonary Embolism in Patients With Cancer and Acute Lower Extremity Deep Venous Thrombosis. JAMA Netw Open 2020; 3:e2011079. [PMID: 32701160 PMCID: PMC7378756 DOI: 10.1001/jamanetworkopen.2020.11079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Venous thromboembolism is the second overall leading cause of death for patients with cancer, and there is an approximately 2-fold increase in fatal pulmonary embolism (PE) in patients with cancer. Inferior vena cava (IVC) filters are designed to prevent PE, but defining the appropriate use of IVC filters in patients with cancer remains a substantial unmet clinical need. OBJECTIVE To evaluate the association of IVC filters with the development of PE in patients with cancer and deep venous thrombosis (DVT). DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted using administrative data on 88 585 patients from the state inpatient databases for California (2005-2011) and Florida (2005-2014). Based on diagnostic and procedure codes, patients with cancer and acute lower extremity DVT were identified. All subsequent hospital visits for these patients were evaluated for the placement of an IVC filter, the development of new PE, the development of new DVT, and in-hospital mortality. Data analysis was performed from September 1 to December 1, 2019. EXPOSURES Placement of an IVC filter. MAIN OUTCOMES AND MEASURES The association of IVC filter placement with rates of new PE and DVT was estimated using a propensity score matching algorithm and competing risk analysis. RESULTS The study cohort comprised 88 585 patients (45 074 male; median age, 71.0 years [range, 1.0-104.0 years]) with malignant neoplasms who presented to a health care institution with a diagnosis of acute lower extremity DVT. Of these patients, 33 740 (38.1%) underwent IVC filter placement; patients with risk factors such as upper gastrointestinal bleeding (odds ratio, 1.32; 95% CI, 1.29-1.37), intracranial hemorrhage (odds ratio, 1.21; 95% CI, 1.19-1.24), and coagulopathy (odds ratio, 1.09; 95% CI, 1.08-1.10) were more likely to receive an IVC filter. A total of 4492 patients (5.1%) developed a new PE after their initial DVT diagnosis. There was a significant improvement in PE-free survival for these patients compared with those who did not receive IVC filters across the full, unbalanced study cohort as well as after propensity score matching and competing risk analysis (hazard ratio, 0.69; 95% CI, 0.64-0.75; P < .001). Furthermore, IVC filter placement reduced the development of PE in patients with very high-risk malignant neoplasms (eg, pancreaticobiliary cancer), high-risk malignant neoplasms (eg, lung cancer), and low-risk malignant neoplasms (eg, prostate cancer). After accounting for anticoagulation use and imbalanced risk factors, IVC filter placement did not increase the risk of new DVT development. CONCLUSIONS AND RELEVANCE This study suggests that, for patients with cancer and DVT and bleeding risk factors, IVC filter placement is associated with an increased rate of PE-free survival.
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Affiliation(s)
- Samyuktha Balabhadra
- Department of Radiology, University of Texas Health McGovern School of Medicine, Houston
| | - Joshua D. Kuban
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Stephen Lee
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Steven Yevich
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Zeyad Metwalli
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Colin J. McCarthy
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Steven Y. Huang
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
| | - Sunil A. Sheth
- Department of Neurology, UTHealth McGovern School of Medicine, Houston, Texas
| | - Rahul A. Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
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Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS):: A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI). J Vasc Surg Venous Lymphat Disord 2020; 8:706-710. [PMID: 32426220 PMCID: PMC7229740 DOI: 10.1016/j.jvsv.2020.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 01/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semiurgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/nonurgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.
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Quencer KB, Smith TA, Deipolyi A, Mojibian H, Ayyagari R, Latich I, Ali R. Procedural complications of inferior vena cava filter retrieval, an illustrated review. CVIR Endovasc 2020; 3:23. [PMID: 32337618 PMCID: PMC7184068 DOI: 10.1186/s42155-020-00113-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Annually, approximately 65,000 inferior vena cava (IVC) filters are placed in the United States (Ahmed et al., J Am Coll Radiol 15:1553-1557, 2018). Approximately 35% of filters are eventually retrieved (Angel et al., J Vasc Interv Radiol 22: 1522-1530 e1523, 2011). Complications during filter retrieval depend heavily on technique and filter position. In this paper, we review risk factors and incidence of complications during IVC filter removal. We also discuss ways these complications could be avoided and the appropriate management if they occur.
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Affiliation(s)
- Keith B Quencer
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA.
| | - Tyler A Smith
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA
| | - Amy Deipolyi
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering, New York, USA
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Raj Ayyagari
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Igor Latich
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Rahmat Ali
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
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Truneh T, Lintin L, Warakaulle D, Mckean D. The role of interventional radiology in elective orthopaedic practice. Br J Hosp Med (Lond) 2020; 81:1-10. [PMID: 32339016 DOI: 10.12968/hmed.2020.0015] [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: 11/11/2022]
Abstract
Interventional radiology is a subspecialty of radiology that provides a range of minimally invasive diagnostic and therapeutic procedures. It continues to expand and evolve, and has had a marked impact on clinical care in many settings, in some cases averting the need for major surgery and hospital admission. While its role in the setting of trauma is relatively well established, with arterial embolisation a valuable option in the management of haemodynamically unstable patients, it is less prominent in the elective setting. This article provides an overview of emerging applications of interventional radiology in the elective treatment of orthopaedic conditions.
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Affiliation(s)
- Teodros Truneh
- Department of Orthogeriatrics, Horton Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Luke Lintin
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dinuke Warakaulle
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
| | - David Mckean
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
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Montaño GS, Quemba MP, González-Jiménez N, Santiago-Mesa M, Vega JD. Tromboprofilaxis durante el embarazo. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.73366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En mujeres, el riesgo de desarrollar enfermedad tromboembólica venosa (ETV) es 5 a 6 veces mayor durante el embarazo, riesgo que puede aumentar considerablemente si existen antecedentes personales o familiares de otros estados protrombóticos. La ETV es una de las principales causas de morbimortalidad en esta población, por lo que para evaluar la pertinencia de usar tromboprofilaxis, ya sea farmacológica o no farmacológica, es necesario reconocer oportunamente los factores de riesgo clínico asociados a esta condición.Objetivo. Describir el uso de pruebas de tamizaje de estados protrombóticos y de la tromboprofilaxis farmacológica y no farmacológica para prevenir la ETV durante la gestación, durante el parto y durante el puerperio.Materiales y métodos. Se realizó una revisión de la literatura en Embase, ClinicalKey, ScienceDirect, Access Medicine, Scopus, ProQuest, PubMed y LILACS. Se buscaron estudios sobre trombofilia y trombofilaxis en el embarazo publicados entre enero de 2004 y marzo de 2018 en inglés y en español.Resultados. En la búsqueda inicial se identificaron 128 artículos, de los cuales 54 cumplieron los criterios de inclusión. La mayoría de estudios correspondió a revisiones narrativas (n=16), guías de práctica clínica (n=13) y revisiones sistemáticas (n=8).Conclusión. Se recomienda el uso de pruebas de tamizaje de estados protrombóticos durante la gestación, el parto y el puerperio, ya que la identificación oportuna de la ETV permitirá disminuir las tasas de morbimortalidad en esta población mediante la implementación de medidas tromboprofilácticas, sean o no farmacológicas.
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