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Fukasawa H, Kameyama A, Tsukada M, Imamura H. Infected aortic pseudoaneurysm caused by an inferior vena cava filter. Acute Med Surg 2022; 9:e767. [PMID: 35959097 PMCID: PMC9360758 DOI: 10.1002/ams2.767] [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: 01/11/2022] [Accepted: 05/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Inferior vena cava filters are widely used to prevent pulmonary embolism, but they can cause serious complications. Case Presentation A 45‐year‐old man with multiple abscesses was transferred to the emergency department from another hospital. Computed tomography revealed bilateral subscapular abscesses, septic pulmonary embolism, and an abdominal aortic pseudoaneurysm with an abscess at the site of the inferior vena cava filter limb inserted 12 years before. After admission to our hospital, surgical drainage of the bilateral subscapular and right wrist joint abscesses was performed; subsequent treatment with ampicillin improved the patient's condition. Inflammation resolved on the 19th hospitalization day, and abdominal aortic replacement surgery was performed. The patient's postoperative course was uneventful. He returned to the previous hospital for rehabilitation after 40 days of hospitalization. Conclusion Inferior vena cava filters could cause serious complications.
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Affiliation(s)
- Hiroaki Fukasawa
- Department of Emergency and Critical Care Medicine Shinshu University School of Medicine Matsumoto Japan
| | - Akiko Kameyama
- Department of Emergency and Critical Care Medicine Shinshu University School of Medicine Matsumoto Japan
| | - Megumi Tsukada
- Department of Emergency and Critical Care Medicine Shinshu University School of Medicine Matsumoto Japan
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine Shinshu University School of Medicine Matsumoto Japan
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2
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Inferior Vena Cava (IVC) Wall Penetration by IVC Filter Detected Incidentally During Retroperitoneal Lymphadenectomy. Indian J Surg Oncol 2021; 12:362-364. [DOI: 10.1007/s13193-021-01372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 06/09/2021] [Indexed: 10/20/2022] Open
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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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Robinson E, Jordano L, Mirza AK, Eisenmenger L, Skeik N, Manunga J. Management of a contained ruptured infrarenal abdominal aortic pseudoaneurysm caused by inferior vena cava struts injury: A case report and literature review. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:438-442. [PMID: 34278079 PMCID: PMC8263528 DOI: 10.1016/j.jvscit.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 11/20/2022]
Abstract
Aortic pseudoaneurysms are rare entities caused by infection, trauma, atherosclerotic plaque rupture, or aortic instrumentation. Their natural course remains unknown; however, repair is invariably recommended. We present a case of a 71-year-old man with a history of recurrent deep venous thrombosis and pulmonary embolisms who underwent an inferior vena cava filter placement 8 years prior and was found to have a 3.6-cm contained ruptured infrarenal aortic pseudoaneurysm on imaging performed for abdominal pain. His pseudoaneurysm was excluded using a Gore Excluder Endoprosthesis. We further reviewed literature on the subject to highlight the various surgical approaches to this lethal condition.
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Affiliation(s)
- Emilie Robinson
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Lia Jordano
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Aleem K. Mirza
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Laura Eisenmenger
- Division of Neuroradiology, Department of Radiology, University of Wisconsin at Madison, Madison, Wisc
| | - Nedaa Skeik
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Jesse Manunga
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
- Correspondence: Jesse Manunga, MD, FACS, Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute @ Abbott Northwestern Hospital, 920 E 28th St, Ste 300, Minneapolis, MN 55407
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Pratt WB, Sandhu HK, Leake SS, Jamshidy I, Sola CN, Afifi RO, Safi HJ, Charlton-Ouw KM. Asymptomatic patients with unsuccessful percutaneous inferior vena cava filter retrieval rarely develop complications despite strut penetrations through the caval wall. J Vasc Surg Venous Lymphat Disord 2019; 8:54-61. [PMID: 31231059 DOI: 10.1016/j.jvsv.2019.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/26/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We established a program for retrieval of inferior vena cava (IVC) filters within our hospital system. When percutaneous retrieval fails, we only recommend open surgical removal for symptoms and other complications. We examined our outcomes with conservative management of unsuccessful percutaneous retrieval and open surgical removal for symptomatic/complicated IVC filters. METHODS All patients with history of IVC filter placement who were referred to us for retrieval between 2010 and 2016 were evaluated. Before retrieval, patients were evaluated for risk of future venous thromboembolic events and ongoing need for IVC filtration. Asymptomatic patients with unsuccessful percutaneous filter retrieval were recommended to have annual follow-up with plain abdominal radiographs and to take daily low-dose aspirin. Patients with symptoms referable to the indwelling filter and those with complications were offered open surgical removal. RESULTS There were 213 patients with a history of IVC filter placement who underwent 220 percutaneous attempts for retrieving 214 IVC filters (four patients had two attempts, one patient had three attempts). Technical success in percutaneously retrieving the filter was 180 of 214 (84.1%) at a median of 5.5 months (interquartile range [IQR], 3.5-9.2) from implant. The median filter dwell time was significantly longer in unsuccessful compared with successful retrieval attempts (8.3 months [IQR, 4.3-15.1 months] vs 5.5 months [IQR, 3.2-8.7 months]; P = .011). Of the 34 filters in 33 patients that could not be retrieved percutaneously, all had either significant filter barb penetration through the caval wall or a tilt angle of greater than 15°. The majority of patients (67%) remained asymptomatic without any further complications over a mean follow-up of 24 months (IQR, 12-50 months). No asymptomatic patients developed symptoms or complications over the follow-up period. Two of the five patients who were symptomatic underwent open surgical removal via minilaparotomy. An additional six patients who failed percutaneous retrieval at other institutions were referred to us for open surgical removal owing to symptoms or complications. Technical success for all open surgical removal of IVC filters was 100%. All patients had resolution of their symptoms after percutaneous or open surgical removal. CONCLUSIONS Asymptomatic patients with unsuccessful percutaneous IVC filter retrieval seem to have low complications in midterm follow-up despite significant filter strut penetration. Without symptoms or other complications, such patients do not require referral for open surgical filter removal. Symptomatic patients can expect low morbidity and resolution of symptoms after percutaneous or open surgical removal. Further studies are needed to determine the cost-effectiveness of routinely removing asymptomatic IVC filters.
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Affiliation(s)
- Wande B Pratt
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Samuel S Leake
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Ida Jamshidy
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Cristina N Sola
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex; Memorial Herman Heart and Vascular Institute, Texas Medical Center, Houston, Tex
| | - Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex; Memorial Herman Heart and Vascular Institute, Texas Medical Center, Houston, Tex
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex; Memorial Herman Heart and Vascular Institute, Texas Medical Center, Houston, Tex
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Tex; Memorial Herman Heart and Vascular Institute, Texas Medical Center, Houston, Tex.
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Desai K, Cook J, Brownie E, Zayed M. Tulip piercing the aorta: a rare case of IVC filter aortic perforation and obstruction. J Surg Case Rep 2018; 2018:rjy280. [PMID: 30386545 PMCID: PMC6204720 DOI: 10.1093/jscr/rjy280] [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: 08/06/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022] Open
Abstract
Prolonged implantation of inferior vena cava (IVC) filters can lead to significant morbidity. We present a 25-year-old man with antiphospholipid syndrome, lower extremity deep vein thrombosis, and subsequent Gunther-Tulip IVC filter placement. More than 10 years following IVC filter placement he developed progressive abdominal and back pains. Cross-sectional angiography revealed that he had a chronic IVC occlusion, and IVC filter limb extensions into the infrarenal aorta, lumbar spine, and right psoas muscle. The IVC filter limb protruding into the aorta had also pierced through the backwall to lead to partial lumen thrombosis and obstruction. The patient underwent a transabdominal exposure of the infrarenal IVC and aorta, filter explantation and aortic patch angioplasty repair. This case highlights the severity of aortic injury from a protruding IVC filter limb that necessitated open aortic repair. Improved selection, monitoring and retrieval stewardship of IVC filters can help reduce the risk of unintended aortic complications.
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Affiliation(s)
- Kshitij Desai
- Section of Vascular Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Jason Cook
- Section of Vascular Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Evan Brownie
- Section of Vascular Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Mohamed Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University, St. Louis, MO, USA.,Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
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Duncan C, Trerotola SO, Stavropoulos SW. Endovascular Removal of Inferior Vena Cava Filters with Arterial Penetration. J Vasc Interv Radiol 2018; 29:486-490. [PMID: 29477624 DOI: 10.1016/j.jvir.2017.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/08/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the safety and outcomes of endovascular percutaneous removal of inferior vena cava filters (IVCFs) with elements penetrating an artery. MATERIALS AND METHODS From an IVCF retrieval database, computerized tomographic scans of patients who underwent IVCF retrieval from 2011 to 2017 were reviewed for IVCF elements penetrating through the caval wall and into an adjacent arterial wall (AW) or penetrating into an adjacent arterial lumen (AL). Forty-two patients were identified, including 20 with elements penetrating into an AW and 22 with elements penetrating into an AL; 30 of these IVCFs were tip embedded. RESULTS All of the filters in both groups were removed. Of the arterial-interacting filters, 9 were removed with the use of standard techniques and 33 with the use of endobronchial forceps. Arterial access was obtained before removal in 3 patients (7%) with post-removal arteriography revealing no abnormalities, such as extravasation, pseudoaneurysm, or new fractured components. There was no significant difference between groups in tip embedding, retrieval technique, or fluoroscopy time. CONCLUSIONS Endovascular removal of IVCFs with elements that have penetrated into adjacent arterial walls or lumens can be performed safely in the majority of patients.
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Affiliation(s)
- Christopher Duncan
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104.
| | - S William Stavropoulos
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104
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Bond JM, Wayne E, Dwivedi AJ, Sigdel A. Successful Percutaneous Retrieval of IVC Filter with Wide Retroperitoneal Penetration Presenting with Gastrointestinal Bleeding. Ann Vasc Dis 2017. [PMID: 29515711 PMCID: PMC5835423 DOI: 10.3400/avd.cr.17-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Symptomatic penetration of the retroperitoneal structures by inferior vena cava (IVC) filter is a rare clinical entity. Vast majority of these patients require laparotomy and open retrieval of the filter. We report a case of a filter penetrating into the duodenum within two months of implantation resulting in gastrointestinal bleeding. The patient was successfully managed with percutaneous retrieval of the filter, blood transfusion and serial abdominal examination thus avoiding laparotomy.
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Affiliation(s)
- Jordan M Bond
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Erik Wayne
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Amit J Dwivedi
- Department of Surgery, University of Louisville, Kentucky, USA
| | - Abindra Sigdel
- Department of Surgery, University of Louisville, Kentucky, USA
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Saeed H, Buxey K, Fitzgerald M. Caval wall injury secondary to inferior vena cava filter removal: a rare complication. ANZ J Surg 2017; 88:240-242. [PMID: 28929607 DOI: 10.1111/ans.14181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Hani Saeed
- Department of Trauma, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kenneth Buxey
- Department of Trauma, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Department of Trauma, Alfred Hospital, Melbourne, Victoria, Australia
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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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Epstein NE. Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients: Two-case study and literature review. Surg Neurol Int 2015; 6:S469-74. [PMID: 26605108 PMCID: PMC4617024 DOI: 10.4103/2152-7806.166877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background: Preoperative “prophylactic” placement of inferior vena cava (IVC) filters in morbidly obese patients (e.g., body mass index [BMI] >40 or BMI over 35 with hypertension/diabetes) undergoing multilevel decompressive lumbar laminectomies may reduce the risk of postoperative pulmonary embolism (PE), and death. Methods: Two patients, ages 69 and 68, with morbid obesity (BMI's of 40.4 and 37.5 both with hypertension and diabetes), received prophylactic IVC filters prior to L1–S1 laminectomies. Intraoperatively and postoperatively, both received alternating compression stocking prophylaxis, and received subcutaneous heparin 5000 U q12 h 48 h after surgery until discharge; none developed deep venous thrombosis (DVT) or PE, and both filters were uneventfully removed within 3 postoperative months. Results: The spinal surgical literature largely supports the placement of IVC filters for major risk factors; obesity (BMI >40), a history of DVT/PE, cancer, fusions, hypercoagulation syndromes, pulmonary/circulatory disorders, preoperative/postoperative immobility, staged procedures (five spinal levels), combined anterior-posterior surgery, iliocaval manipulation, age >80, and prolonged surgery (e.g., >261 min vs. >8 h). Although the safety and efficacy of prophylactic IVC filters for spine surgery in patients with morbidly obesity are well substantiated, those for bariatric patients are less clear. Conclusions: Prophylactic IVC filters were successfully placed/retrieved in 2 morbidly obese patients, ages 68 and 69, undergoing L1–S1 lumbar decompressions. Although the spine surgery literature documents the safety/efficacy of prophylactic IVC filters in patients with morbid obesity, the bariatric literature still has major concerns.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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