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Cao P, Luo X, Li Y, Liu X, Li L, Dou Y, Zhang Y. Removing infrarenal inferior vena cava filters (IVCFs) with thrombus under protection of suprarenal IVCFs: A retrospective study in a single-center institution. Medicine (Baltimore) 2023; 102:e35574. [PMID: 37861528 PMCID: PMC10589510 DOI: 10.1097/md.0000000000035574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
To determine feasibility of removing inferior vena cava filters (IVCFs) with massive thrombus (>1*1cm) under protection of suprarenal IVCFs, and evaluate the filter thrombus detachment due to removal. The patients who had massive infrarenal IVCFs thrombus and received retrieval under protection of suprarenal IVCFs were retrospectively reviewed from July 2018 to December 2021. Medical data of them including demographics, filter types, dwell time, management, thrombus detachment was collected, and analyzed. There were 33 patients having massive infrarenal IVCFs thrombus and receiving retrieval under protection of suprarenal IVCFs including 23 males and 10 females with a mean age of 55.30 ± 11.97 (range, 30-85 years). All Infrarenal IVCFs were removed successfully and 29 cases (87.88%) were confirmed detachment of thrombus by cavography including 7 small-size thrombus (<1*1cm) and 22 large-size thrombus (>1*1cm). Twenty-two suprarenal IVCFs trapped large-size thrombus were treated with additional anticoagulation and 21 of them had successful retrievals with additional anticoagulation period of 66.18 ± 43.38 days (range, 9-154 days). The large-size IVCFs thrombus may be break off during retrieval, and IVCFs with large-size thrombus could be removed safely with suprarenal IVCFs protection. The thrombus trapped in filters could be reduced with an additional period of anticoagulation.
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Affiliation(s)
- Pengkai Cao
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xintong Luo
- Neurology Department of Hebei General Hospital, Shijiazhuang, China
| | - Yunsong Li
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangdong Liu
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Li
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaodong Dou
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanrong Zhang
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
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2
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Siah TH, Habib Z, McWilliams RG, Chan TY. Implications for patient follow-up of changes in inferior vena cava filter removal plan practices. Clin Radiol 2022; 77:794-799. [PMID: 35985844 DOI: 10.1016/j.crad.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
AIM To assess the improvements during patient follow-up after implementing a proactive plan for retrieval of inferior vena cava (IVC) filters. MATERIALS AND METHODS A retrospective study was undertaken including all patients who had a temporary IVC filter inserted over a 10-year period. Patient demographics, insertion dates, retrieval dates, retrieval rates, and complications were recorded. Patients were categorised into three groups as follows: group A, no intervention where retrieval was not suggested; group B, passive intervention where retrieval was suggested but no appointment made; and group C, proactive intervention where a retrieval date was booked by the radiologist. RESULTS Five hundred and nine patients had a temporary IVC filter inserted at Royal Liverpool University Hospital over the study period. One per cent of patients in group C were lost to follow-up compared to 41% and 29% in groups A and B respectively (p<0.001). The number of patients who had an IVC retrieval attempt also increased to 80% in group C compared to 53% and 64% in groups A and B (p<0.001). CONCLUSION Incorporation of a proactive retrieval booking system has significantly reduced the number of patients lost to follow-up to 1%, leading to an increased number of IVC filter retrieval attempts.
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Affiliation(s)
- T H Siah
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK.
| | - Z Habib
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - R G McWilliams
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - T Y Chan
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
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3
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Sakai R, Fujiki S, Kashimura T, Tsuchiya H, Takahashi K, Ozaki K, Okura Y, Hanzawa K, Inomata T. Long-Term Outcomes in Patients with Not-Retrieval Inferior Vena Cava Filter Under Anticoagulation. Int Heart J 2022; 63:306-311. [PMID: 35354751 DOI: 10.1536/ihj.21-814] [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] [Indexed: 11/18/2022]
Abstract
Since permanent inferior vena cava (IVC) filters increase deep vein thrombosis (DVT), filter retrieval should be performed as possible. Despite the guideline recommendation, IVC filters are not always retrieved in clinical practice. To date, many patients with not-retrieval IVC filters have been prescribed anticoagulant therapy, but the long-term prognosis, including venous thromboembolism (VTE) and bleeding events, remains unknown. In this study, 195 patients who underwent IVC filter implantation between 2006 and 2017 at 3 institutions in Niigata City have been investigated about their deaths, VTE recurrence, and bleeding events. After peaking 2009, the number of IVC filter implantation gradually decreased. During observational period, there were 158 patients with not-retrieval IVC filters (the overall retrieval rate of 19.0%). The not-retrieval group included significantly older and more patients with cancer compared to the retrieval group. Anticoagulation therapy was continued in 88% of the not-retrieval group. During a mean follow-up of 5.0 years, 6 symptomatic DVT events associated with inadequate control of anticoagulation and 13 bleeding events were observed. A total of 52 patients died and only the presence of cancer was prognostic risk factor. Although long-term anticoagulation therapy may be associated with bleeding events, there were few recurrent VTE under optimal anticoagulation. It is anticipated that even if the IVC filter cannot be retrieved, appropriate anticoagulation is useful for prevention of DVT recurrence despite the risk of bleeding.
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Affiliation(s)
- Ryohei Sakai
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Shinya Fujiki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Takeshi Kashimura
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | | | | | - Kazuyuki Ozaki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Yuji Okura
- Department of Cardiology, Niigata Cancer Center Hospital
| | - Kazuhiko Hanzawa
- Department of Advanced Treatment and Prevention for Vascular Disease and Embolism, Niigata University Graduate School of Medical and Dental Sciences
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences
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4
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Wang H, Liu Z, Zhu X, Liu J, Man L. Retroperitoneal Laparoscopic-Assisted Retrieval of Wall-Penetrating Inferior Vena Cava Filter After Endovascular Techniques Failed: An Initial Clinical Outcome. Vasc Endovascular Surg 2021; 55:706-711. [PMID: 34080447 DOI: 10.1177/15385744211022517] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed. PATIENTS AND METHODS We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months. RESULTS The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients' hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence. CONCLUSIONS Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.
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Affiliation(s)
- Haidong Wang
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Xiaofei Zhu
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Jianlong Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China
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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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