1
|
Goodman DA, Farr E, Rydberg L. Inferior vena cava filter migration to the heart after stroke: a case report. Top Stroke Rehabil 2024:1-5. [PMID: 39126671 DOI: 10.1080/10749357.2024.2387481] [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: 01/06/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024]
Abstract
This case report discusses the functional outcomes and multidisciplinary coordination of care for a patient with hemiplegia due to stroke complicated by a migrated inferior vena cava (IVC) filter embedded in the right side of the heart. The patient suffered an acute right-sided stroke with hemorrhagic transformation requiring hemicraniectomy with left hemiplegia. The patient developed a subsequent pulmonary embolism requiring IVC filter placement as anticoagulation was contraindicated due to risk of further intracranial hemorrhage. The IVC filter was later identified bridging the tricuspid valve, and surgical intervention was contraindicated requiring a coordinated plan to delay surgical removal of the filter in order to allow for optimization of the patient's functional and medical status. The patient underwent extensive telemetry monitoring in the intensive care unit to verify no significant cardiac arrhythmia developed with physical activity and was ultimately cleared for admission to acute inpatient rehabilitation. There was a well-coordinated effort between the cardiac, surgical, intensive care, and rehabilitation teams to transition to the inpatient rehabilitation facility to minimize risk and enhance recovery. The patient demonstrated functional improvement throughout rehabilitation and was discharged home with family with eventual surgical removal of the IVC filter. This case highlights the importance of collaboration across multiple disciplines to maximize patient rehabilitation and function, particularly in the context of atypical complications.
Collapse
Affiliation(s)
- Daniel A Goodman
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen Farr
- Physical Medicine & Rehabilitation, Brain Injury Medicine, Department of Physical Medicine & Rehabilitation, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Leslie Rydberg
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Patel DM, Di Capua JF, Rouhezamin MR, Uppot RN, Kalva SP. Retrieval of a Greenfield Inferior Vena Cava Filter Indwelling for 29 Years. Vasc Endovascular Surg 2024; 58:640-644. [PMID: 38279905 DOI: 10.1177/15385744241231134] [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] [Indexed: 01/29/2024]
Abstract
Inferior vena cava (IVC) filters are used to prevent fatal and nonfatal pulmonary embolism in patients who otherwise cannot receive anticoagulation for venous thrombosis. While generally safe and effective, complications can arise, especially after prolonged implantation. Timely retrieval is essential once the indication for insertion has resolved. However, encountering patients with long-standing embedded filters is not uncommon. This case report discusses the successful retrieval of a permanent Greenfield IVC filter after 29 years.
Collapse
Affiliation(s)
- Dipesh M Patel
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Di Capua
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Reza Rouhezamin
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raul N Uppot
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Ladak R, Sementilli M, Calandra J, Lazo-Langner A, Siegal D, Wang TF, Luo R, Cervi AL. Physician practice patterns on the use of inferior vena cava filters in venous thromboembolism. Res Pract Thromb Haemost 2024; 8:102540. [PMID: 39268016 PMCID: PMC11387688 DOI: 10.1016/j.rpth.2024.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/25/2024] [Accepted: 07/26/2024] [Indexed: 09/15/2024] Open
Affiliation(s)
- Rahman Ladak
- Department of Undergraduate Medical Education, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Massimo Sementilli
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | | | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Deborah Siegal
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rong Luo
- Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
| | - Andrea L Cervi
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
- WE-SPARK Health Institute, Windsor, Ontario, Canada
- Departments of Medicine and Oncology, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| |
Collapse
|
4
|
Kim BJ, Lee C. Optimizing inferior vena cava filter design: A computational fluid dynamics study on strut configuration for enhanced hemodynamic performance and thrombosis reduction. Heliyon 2024; 10:e32667. [PMID: 38912484 PMCID: PMC11193039 DOI: 10.1016/j.heliyon.2024.e32667] [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: 01/25/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background and objective Inferior vena cava filters have been shown to be effective in preventing deep vein thrombosis and its secondary complication, pulmonary embolism, thereby reducing the high mortality rate. Although inferior vena cava filters have evolved, specific complications like inferior vena cava thrombosis-induced deep vein thrombosis worsening and recurrent pulmonary embolism continue to pose challenges. This study analyzes the effects of geometric parameter variations of inferior vena cava filters, which have a significant impact on the thrombus formation inside the filter, the capture, dissolution, and hemodynamic flow of thrombus, as well as the shear stress on the filter and vascular wall. Methods This study used computational fluid dynamic simulations with the carreau model to investigate the impact of varying inferior vena cava filter design parameters (number of struts, strut arm length, and tilt angle) on hemodynamics. Results Recirculation and stagnation areas due to flow velocity and pressure, along with wall shear stress values, were identified as key factors. It is important to find a balance between wall shear stress high enough to aid thrombolysis and low enough to prevent platelet activation. The results of this paper show that the risk of platelet activation and thrombus filtration may be lowest when the wall shear stress of the filter ranges from 0 to 4 [Pa], minimizing stress concentration within the filter. Conclusion 16 arm struts with a length of 20 mm and a tilt angle of 0° provide the best balance between thrombus capture and minimization of hemodynamic disturbance. This configuration minimizes the size of the stagnation and recirculation zones while maintaining sufficient wall shear stress for thrombus dissolution.
Collapse
Affiliation(s)
- Byeong-Jun Kim
- Department of Biomedical Engineering, Graduate School, Pusan National University, Busan 49241, Republic of Korea
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Busan 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
| |
Collapse
|
5
|
Bui A, Gillan R, Vaughn A, Bui A, Sherard D. Delayed Arterial Hemorrhage From a Lumbar Artery Following Inferior Vena Cava Filter Placement: A Case Report. Cureus 2024; 16:e60668. [PMID: 38899243 PMCID: PMC11186399 DOI: 10.7759/cureus.60668] [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] [Received: 04/22/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) is a feared complication of deep venous thrombosis (DVT) that can lead to respiratory distress and even death. The mainstay of preventing PE is anticoagulation, but other strategies exist. Inferior vena cava (IVC) filters are an alternative strategy for PE prophylaxis in individuals who may have contraindications to receiving anticoagulation. Although the placement of an IVC filter is a minimally invasive and typically uncomplicated procedure, all procedures have their risks. We present a case of a 35-year-old woman who experienced a rare complication of IVC filter placement and suffered a retroperitoneal hemorrhage. The patient underwent placement of an IVC filter for PE prophylaxis before a scheduled sleeve gastrectomy. Hours after placement, she returned with new symptoms and signs of blood loss. She was found to have a retroperitoneal hematoma due to bleeding from a lumbar artery that was penetrated by a strut of the filter. Arterial hemorrhage from a lumbar artery is a rare complication of IVC filter placement, and it can result in poor outcomes for the patient. We aim to increase awareness of this rare but dangerous complication to improve recognition and patient outcomes in cases of delayed arterial hemorrhage following IVC filter placement.
Collapse
Affiliation(s)
- Audrey Bui
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Ross Gillan
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Austin Vaughn
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Arden Bui
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Douglass Sherard
- Interventional Radiology, Ascension St. Vincent's Hospital, Jacksonville, USA
| |
Collapse
|
6
|
Liu Y, Ma J, Wang Q, Zeng W, He C. Successful retrieval of tip-embedded inferior vena cava filter using a modified forceps technique: case report. Thromb J 2024; 22:25. [PMID: 38475817 DOI: 10.1186/s12959-024-00595-7] [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: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The retrieval of inferior vena cava (IVC) filter is essential for preventing complications associated with the device. Advanced techniques have been developed to improve the success rate of retrieving tip-embedded filters. The forceps technique is frequently used to address this issue. CASE PRESENTATION We present a case study of two patients who underwent a successful tip-embedded IVC filter retrieval using a modified forceps technique, which has not been previously reported. This technique involves using a wire loop under the filter tip and a forceps to grasp the filter shoulder. By pulling the wire loop and pushing the forceps in counterforce, the filter tip is straightened and aligned with the vascular sheath. The vascular sheath can then dissect the filter tip out from the caval wall and get inside the sheath to complete the retrieval. CONCLUSIONS The modified forceps technique we present here offers a new solution for the complex retrieval of IVC filters.
Collapse
Affiliation(s)
- Yang Liu
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Junlong Ma
- Department of Hepato-biliary-pancreatic and Vascular surgery, Meishan municipal people's hospital, Meishan, Sichuan, CN, China
| | - Qiqi Wang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Wei Zeng
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, 610072, Chengdu, Sichuan, CN, China.
| |
Collapse
|