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Choi PJ, Kabeil M, Furtado Neves PJ, Labropoulos N, Zil-E-Ali A, Aziz F, Malgor EA, Malgor RD. Urological complications caused by inferior vena cava filters: a systematic review. INT ANGIOL 2024; 43:247-254. [PMID: 38619204 DOI: 10.23736/s0392-9590.24.05041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review. EVIDENCE ACQUISITION A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication. EVIDENCE SYNTHESIS Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported. CONCLUSIONS Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.
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Affiliation(s)
- Paul J Choi
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Pedro J Furtado Neves
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Ahsan Zil-E-Ali
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Faisal Aziz
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Emily A Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Rafael D Malgor
- Division of Vascular Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA -
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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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Al Manasra ARA, Tawalbeh RA, Al-Qaoud DI, Ayesh MH, Al-Omari MH, Manasreh T, Fataftah J. Migrated Inferior Vena Cava (IVC) Filter Strut: A Rare Cause of Chronic Distal Pancreatitis with Likely Malignant Transformation. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929599. [PMID: 33707408 PMCID: PMC7957838 DOI: 10.12659/ajcr.929599] [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] [Indexed: 12/05/2022]
Abstract
Patient: Female, 44-year-old Final Diagnosis: Pancreatic adenocarcinoma Symptoms: Abdominal pain Medication:— Clinical Procedure: Neoplasm Specialty: Surgery
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Affiliation(s)
- Abdel Rahman A Al Manasra
- Departmet of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra'fat A Tawalbeh
- Departmet of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Doaa I Al-Qaoud
- Departmet of Pediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mahmoud H Ayesh
- Departmet of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mamoon H Al-Omari
- Departmet of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarek Manasreh
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jehad Fataftah
- Department of Radiology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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DeSai C, Lamus D, Kumar G. Arteriovenous Fistula-A Rare Complication of IVC Filter Retrieval. Vasc Endovascular Surg 2019; 53:501-506. [PMID: 31159685 DOI: 10.1177/1538574419849998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inferior vena cava (IVC) filters are important devices for patients who are at high risk for developing thrombi and pulmonary embolism but have conditions that preclude the use of pharmacologic anticoagulants. IVC filter retrieval has become an important quality initiative backed by Food and Drug Administration guidelines for prompt removal after the filter is no longer indicated. Filter retrieval is a common procedure that usually has very few complications. However, when the filter is tilted or embedded in the caval wall, advanced techniques of retrieval may be necessary. These techniques have a higher rate of success but also a higher risk of complications such as injury to the IVC. Here, we describe a case of IVC filter retrieval resulting in formation of an arteriovenous fistula between the right renal artery and IVC and subsequent successful repair of this fistula using a vascular plug.
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Affiliation(s)
- Charisma DeSai
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Lamus
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Girish Kumar
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Taylor SG, Jung HK, Gerson D, van Rij AM. Open retrieval of an inferior vena cava filter penetrating into a horseshoe kidney. J Vasc Surg Venous Lymphat Disord 2018; 6:758-761. [PMID: 29914812 DOI: 10.1016/j.jvsv.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/11/2018] [Indexed: 10/28/2022]
Abstract
Retrievable inferior vena cava filters carry a risk of penetrating into adjacent structures, which may necessitate open retrieval. We report a unique case of a retrievable inferior vena cava filter penetrating into an overlying horseshoe kidney, leading to clinical hematuria. After repeated failed endovascular retrieval, an open approach with associated access challenges was required.
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Affiliation(s)
- Sam G Taylor
- Department of Surgery, Dunedin Hospital and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Hong K Jung
- Department of Surgery, Dunedin Hospital and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Gerson
- Department of Radiology, Dunedin Hospital and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andre M van Rij
- Department of Surgery, Dunedin Hospital and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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McKelvie M, Thayur N, Sebastian A, Howard A. A case of hepatic, renal and duodenal penetration by a Celect inferior vena caval filter. BMJ Case Rep 2017; 2017:bcr-2017-220580. [PMID: 28611173 DOI: 10.1136/bcr-2017-220580] [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: 11/04/2022] Open
Abstract
Inferior vena caval (IVC) filters are used as a mechanical option for the treatment of venous thromboembolism (VTE) when standard anticoagulation therapy is either contraindicated or VTE recurs despite adequate anticoagulation. Filters are not without risk, however. Reported complications include filter migration and fracture of filter components, leading to IVC rupture and penetration into pericaval tissues (notably kidney, heart, pericardium, thoracic cavity, liver, bowel and aorta). Here we describe an extreme case of multiple organ penetration by a standard Celect caval filter.
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Affiliation(s)
- Mark McKelvie
- University of Cambridge School of Clinical Medicine, Cambridge, UK.,Bedford Hospital NHS Trust, Bedford, UK
| | - Nagendra Thayur
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Arun Sebastian
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Adam Howard
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
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Abstract
Inferior vena cava (IVC) filter placement is a relatively low risk alternative for prophylaxis against pulmonary embolism in patients with pelvic or lower extremity deep venous thrombosis who are not suitable for anticoagulation. There is an increasing trend in the number of IVC filter implantation procedures performed every year. There are many device types in the market and in the early 2000s, the introduction of retrievable filters brought an additional subset of complications to consider. Modern filter designs have led to decreased morbidity and mortality, however, a thorough understanding of the limitations and complications of IVC filters is necessary to weight the risks and benefits of placing IVC filters. In this review, the complications associated with IVC filters are divided into procedure related, post-procedure, and retrieval complications. Differences amongst the device types and retrievable filters are described, though this is limited by a significant lack of prospective studies. Additionally, the clinical presentation as well as prevention and treatment strategies are outlined with each complication type.
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Affiliation(s)
- Simer Grewal
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Murthy R Chamarthy
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Abdel-Aal AK, Ezzeldin IB, Moustafa AS, Ertel N, Oser R. Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury. J Radiol Case Rep 2015; 9:37-43. [PMID: 27200175 DOI: 10.3941/jrcr.v9i12.2508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple's pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure.
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Affiliation(s)
- Ahmed Kamel Abdel-Aal
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
| | - Islam B Ezzeldin
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
| | - Amr Soliman Moustafa
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
| | - Nathan Ertel
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
| | - Rachel Oser
- Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama. USA
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Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration. Cardiovasc Intervent Radiol 2015; 38:1192-7. [PMID: 25795475 DOI: 10.1007/s00270-015-1077-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study is to evaluate the influence of respiratory-induced vena caval hemodynamic changes on filter migration/penetration. MATERIALS AND METHODS After placement of either a Gunther Tulip or Celect IVC filter, 101 consecutive patients scheduled for filter retrieval were prospectively enrolled in this study. Pre-retrieval CT scans were used to assess filter complications and to calculate cross-sectional area in three locations: at level of filter strut fixation, 3 cm above and 3 cm below. A 3D finite element simulation was constructed on these data and direct IVC pressure was recorded during filter retrieval. Cross-sectional areas and pressures of the vena cava were measured during neutral breathing and in Valsalva maneuver and identified filter complications were recorded. A statistical analysis of these variables was then performed. RESULTS During Valsalva maneuvers, a 60 % decrease of the IVC cross-sectional area and a fivefold increase in the IVC pressure were identified (p < 0.001). There was a statistically significant difference in the reduction of the cross-sectional area at the filter strut level (p < 0.001) in patient with filter penetration. Difficulty in filter retrieval was higher in penetrated or tilted filters (p < 0.001; p = 0.005). 3D computational models showed significant IVC deformation around the filter during Valsalva maneuver. CONCLUSION Caval morphology and hemodynamics are clearly affected by Valsalva maneuvers. A physiological reduction of IVC cross-sectional area is associated with higher risk of filter penetration, despite short dwell times. Physiologic data should be used to improve future filter designs to remain safely implanted over longer dwell times.
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