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Matsumoto MM, Cun A, DeSanto C, Paycardo A, Stavropoulos SW, Trerotola SO. Managing an effective system for retrieving IVC filters: outcomes of a prospective patient database, 2012-2023. CVIR Endovasc 2025; 8:35. [PMID: 40289055 PMCID: PMC12034602 DOI: 10.1186/s42155-025-00550-1] [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: 02/28/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
PURPOSE To evaluate retrievable inferior vena cava (IVC) filter outcomes with a prospectively maintained database and active patient management by interventional radiology (IR). MATERIALS & METHODS Patients with retrievable IVC filters placed by IR from 2012 to 2023 at a single, tertiary institution were tracked in a prospective registry, and follow-up was organized by a designated IR physician assistant. Patients were contacted after the filter was placed by IR and a clinic visit arranged; filter removal was scheduled when deemed appropriate. Retrospective review of filter outcomes, including retrieval, patient death, and need for permanent filtration, was performed. RESULTS Over the 12-year study period, 607 retrievable IVC filters were placed: 516 Denali, 63 Eclipse, 19 Günther Tulip, and 9 Celect Platinum. In total, 43% (260) were retrieved, 12% (75) were adjudicated to be permanent, and 42% (253) died with the filter in place. The remaining 3% (19) comprised patients alive with the filter not yet retrieved at study endpoint, 42% (8/19) of which were placed in 2023. Of this cohort, 8 still needed the filter and were being monitored to determine follow-up timing, 2 needed a follow-up appointment, and 9 were lost to follow-up due to repeated no-shows and/or inability to reach the patient despite multiple attempts. Overall, 1.5% (9/607) of all filters placed were not accounted for. CONCLUSION This study demonstrates high accountability (98.5%) of retrievable IVC filters when using a prospective registry actively managed by an IR PA, providing an effective and feasible model for facilitating appropriate follow-up.
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Affiliation(s)
- Monica M Matsumoto
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Ann Cun
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Corinne DeSanto
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Anna Paycardo
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - S William Stavropoulos
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Scott O Trerotola
- Section of Interventional Radiology, Department of Radiology, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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2
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Qin L, Tian F, Wang K, Mao Y, Hu L, Xue T, Jia Z, Tao T. A Multidisciplinary Quality Improvement Project Leads to Improved Patient Follow-up and Filter Retrieval Rate. Ann Vasc Surg 2025; 112:373-380. [PMID: 39732325 DOI: 10.1016/j.avsg.2024.12.056] [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: 01/18/2024] [Revised: 07/18/2024] [Accepted: 12/18/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND To identify risk factors for loss to follow-up after inferior vena cava (IVC) filter placement in inpatients of other departments (IODs) and to determine whether a quality improvement project launched at our institution in April 2022 improved follow-up and filter retrieval rates in these patients. METHODS Consecutive patients who underwent retrievable filter placement at our institution between March 2021 and March 2023 were included in this study. Patients were divided into preimprovement (before April 2022; n = 81) and postimprovement (after April 2022; n = 77) groups. Risk factors for loss to follow-up were assessed in the preimprovement group, and filter retrieval rates were compared between groups. RESULTS Acute cerebral hemorrhage (OR = 5.745; 95% CI: 1.471-22.434) and lack of requirement for follow-up by the referring department (OR = 3.435; 95% CI: 1.035-11.398) were identified as independent risk factors for loss to follow-up. The filter retrieval rate was higher in the postimprovement group (94.8%) than in the preimprovement group (69.1%; P < 0.001). The rate of loss to follow-up was lower in the postimprovement group (5.2%) than in the preimprovement group (30.9%; P < 0.001). The preimprovement group had a higher incidence of IVC perforation (9.6%) than the postimprovement group (0; P = 0.019) at the time of filter retrieval. CONCLUSION Acute cerebral hemorrhage and lack of requirement for follow-up by the referring department are independent risk factors for loss to follow-up among IODs. The quality improvement project at our institution improved follow-up and IVC filter retrieval rates in IODs.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Feng Tian
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Youjun Mao
- Department of Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Linghong Hu
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City (Huaian Cancer Hospital), Huai'an, China.
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
| | - Tao Tao
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
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Fioretti AM, La Forgia D, Scicchitano P, Brunetti ND, Inchingolo R, Tocchetti CG, Oliva S. Inferior Vena Cava Filter in Cancer-Associated Thrombosis: A Vade Mecum for the Treating Physicians: A Narrative Review. Biomedicines 2024; 12:2230. [PMID: 39457543 PMCID: PMC11505388 DOI: 10.3390/biomedicines12102230] [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: 08/13/2024] [Revised: 09/22/2024] [Accepted: 09/24/2024] [Indexed: 10/28/2024] Open
Abstract
Cancer is a remarkable prothrombotic disease, and cancer-associated thrombosis acts as a dreadful omen for poor prognosis. The cornerstone of venous thromboembolism therapy is anticoagulation; however, in patients with venous thromboembolism who are not suitable for anticoagulation (contraindication, failure, or complication), the inferior vena cava filter appears a valuable option in the therapeutic arsenal. The recently heightened trend of steady rise in filter placement mirrors the spread of retrievable devices, together with improvements in physicians' insertion ability, medico-legal issue, and novel and fewer thrombogenic materials. Nevertheless, the exact role of the inferior vena cava filter in cancer has yet to be endorsed due to a dearth of robust evidence. Indeed, data that support the inferior vena cava filter are weak and even controversial, resulting in discrepancies in the interpretation and application of guidelines in daily practice. In this narrative review, we aim at clarifying the state of the art on inferior vena cava filter use in malignancies. Furthermore, we provide a feasible, conclusive 4-step algorithm for the treating physicians in order to offer a practical strategy to successfully employ the inferior vena cava filter as a priceless device in the current armamentarium against cancer.
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Affiliation(s)
- Agnese Maria Fioretti
- Cardio-Oncology Unit, IRCCS Istituto Tumori, “Giovanni Paolo II”, 70124 Bari, Italy; (A.M.F.); (S.O.)
| | - Daniele La Forgia
- Breast Radiology Department, IRCCS Istituto Tumori, “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Pietro Scicchitano
- Cardiology-Intensive Care Unit, Ospedale della Murgia “Fabio Perinei”, Altamura, 70022 Bari, Italy
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva, 70021 Bari, Italy;
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), “Federico II” University of Naples, 80131 Napoli, Italy;
- Center for Basic and Clinical Immunology Research (CISI), “Federico II” University of Naples, 80131 Napoli, Italy
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), “Federico II” University of Naples, 80131 Napoli, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), “Federico II” University of Naples, 80131 Napoli, Italy
| | - Stefano Oliva
- Cardio-Oncology Unit, IRCCS Istituto Tumori, “Giovanni Paolo II”, 70124 Bari, Italy; (A.M.F.); (S.O.)
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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; 50:851-865. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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5
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Qin L, Wang K, Tian F, Xue T, Jia Z, Li S. A change in strategy for filter choice leads to improved filter retrieval rates. Heart Vessels 2024; 39:640-645. [PMID: 38310515 DOI: 10.1007/s00380-024-02371-z] [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: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To assess whether a new strategy for the choice of inferior vena cava filter placed would improve filter retrieval rates at our institution. METHODS Consecutive patients who underwent retrievable filter placement for temporary embolic protection between January 2021 and January 2023 were considered for study inclusion. Risk factors for nonretrieval of short-term filters were identified in patients receiving filters between January 2021 and January 2022 (prestrategy group). For patients treated between February 2022 and January 2023 (poststrategy group), a long-term filter was recommended for those with these risk factors, and a short-term filter was recommended for those without these risk factors. RESULTS The study population included 303 patients (prestrategy group, n = 154; poststrategy group, n = 149). Long-term immobilization (odds ratio [OR] = 38.000; 95% confidence interval [CI]: 6.858-210.564), active cancer (OR = 17.643; 95% CI: 5.462-56.993), and venous thromboembolism detected in the intensive care unit (OR = 28.500; 95% CI: 7.419-109.477) were identified as independent risk factors for nonretrieval of short-term filters. The total retrieval rate was significantly higher in the poststrategy group (87.2%) than in the prestrategy group (72.7%; P = 0.002); the short-term filter retrieval rate was also significantly higher in the poststrategy group (84.5%) than in the prestrategy group (68.5%; P < 0.001). CONCLUSION The proposed strategy for filter choice based on risk factors for short-term filter nonretrieval can accurately identify patients who need long-term filter placement while also increasing the retrieval rates for both short-term filters retrieval rates and overall retrieval rates.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Feng Tian
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City (Huaian Cancer Hospital), Huai'an, 223200, China.
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China.
| | - Shaoqin Li
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China.
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6
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Banks CA, Passman MA. Appropriateness guidelines for inferior vena cava filter utilization: A contemporary review. Semin Vasc Surg 2024; 37:164-178. [PMID: 39151996 DOI: 10.1053/j.semvascsurg.2024.04.002] [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: 02/05/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 08/19/2024]
Abstract
Concern regarding the exponential increase in optional utilization of inferior vena cava filters (IVCFs) in the early 2000s with a persistent low retrieval rate nationwide has resulted in increased scrutiny regarding clinical application of IVCFs. IVCFs are used in a variety of clinical scenarios, ranging from thromboembolic protection in patients with deep venous thrombosis and contraindication to anticoagulation to prophylactic deployment in multitrauma and critically ill patients. Evidence supporting IVCFs as mechanical thromboembolic protection in certain clinical scenarios has been established through evidenced-based guidelines. As an adjunct to evidence-based guidelines, appropriateness criteria to address specific clinical scenarios and facilitate clinical decision making when considering placement of an IVCF have been developed. In this review, current evidence-based and appropriateness guidelines are summarized.
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Affiliation(s)
- C Adam Banks
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Marc A Passman
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
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Serrano E, Vila-Trias E, Zarco F, Zamora Martínez C, Moisés J, Gómez FM, López-Rueda A. Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables. RADIOLOGIA 2023; 65:230-238. [PMID: 37268365 DOI: 10.1016/j.rxeng.2022.07.006] [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: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.
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Affiliation(s)
- E Serrano
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - E Vila-Trias
- Servicio Radiología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - F Zarco
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - J Moisés
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - F M Gómez
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
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Dehbi S, Grange R, Poenou G, Ayoub E, Boutet C, Barral FG, Bertoletti L, Grange S. Temporary inferior vena cava filters factors associated with non-removal. Eur Radiol 2023; 33:2585-2592. [PMID: 36517606 DOI: 10.1007/s00330-022-09266-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/26/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Inferior vena cava filter (IVCF) placement is indicated when there is a deep vein thrombosis and/or a pulmonary embolism and a contraindication of anticoagulation. Due to the increased risk of recurrent deep venous thrombosis when left in place, IVCF removal is indicated once anticoagulant treatment can be reintroduced. However, many temporary IVCF are not removed. We aimed to analyze the removal rate and predictors of filter non-removal in a university hospital setting. METHODS We collected all the data of consecutive patients who had a retrievable IVCF inserted at the Saint-Etienne University Hospital (France) between April 2012 and November 2019. Rates of filter removal were calculated. We analyzed patient characteristics to assess factors associated with filter non-removal, particularly in patients without a definitive filter indication. The exclusion of this last category of patients allowed us to calculate an adjusted removal rate. RESULTS The overall removal rate of IVCF was 40.5% (IC 95% 35.6-45.6), and the adjusted removal rate was 62.9 % (IC 95% 56.6-69.2%). No major complications were noted. Advanced age (p < 0.0001) and cancer presence (p < 0.003) were statistically significant predictors of patients not being requested to make a removal attempt. CONCLUSIONS Although most of the filters placed are for therapeutic indications validated by scientific societies, the removal rate in this setting remains suboptimal. The major factors influencing IVCF removal rate are advanced age and cancer presence. KEY POINTS • Most vena cava filters are placed for therapeutic indications validated by scientific societies. • Vena cava filter removal rates in this setting remain suboptimal. • Major factors influencing IVCF removal rate are advanced age and cancer presence.
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Affiliation(s)
- Sabrina Dehbi
- CHU de St-Etienne, Service de Radiologie, Hôpital Nord, CHU de St-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Rémi Grange
- CHU de St-Etienne, Service de Radiologie, Hôpital Nord, CHU de St-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Geraldine Poenou
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Elie Ayoub
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Claire Boutet
- CHU de St-Etienne, Service de Radiologie, Hôpital Nord, CHU de St-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Fabrice-Guy Barral
- CHU de St-Etienne, Service de Radiologie, Hôpital Nord, CHU de St-Etienne, Avenue Albert Raimond, Saint-Etienne, France
| | - Laurent Bertoletti
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, Avenue Albert Raimond, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Sylvain Grange
- CHU de St-Etienne, Service de Radiologie, Hôpital Nord, CHU de St-Etienne, Avenue Albert Raimond, Saint-Etienne, France.
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9
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Goh GS, Ng N, Fitzgerald M, Mathew J. Retrieval of a Cook Celect inferior vena cava (IVC) filter after prolonged dwell time of 5,117 days: Factors to consider for retrieval of long-dwell IVC filters. J Med Imaging Radiat Oncol 2023; 67:283-287. [PMID: 36692006 DOI: 10.1111/1754-9485.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/31/2022] [Indexed: 01/25/2023]
Abstract
Inferior vena cava (IVC) filters are used in certain patients to help prevent the occurrence of pulmonary embolism (PE). IVC filters are generally recommended to be removed once PE prophylaxis is no longer required. Long-dwelling IVC filters are associated with higher complication rates (Vasa 2020; 49: 449), being more difficult to retrieve and associated with higher retrieval complications (Cardiovasc Diagn Ther 2016; 6: 632). This report describes the pre-procedural work-up and removal of an IVC filter with a prolonged dwell time of 5,117 days (14 years, 3 days) using the loop snare advanced retrieval technique. As far as the authors are aware this case is the longest-described successful retrieval of a Cook Celect IVC filter at 5,117 days.
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Affiliation(s)
- Gerard S Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nico Ng
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
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10
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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: 7] [Impact Index Per Article: 3.5] [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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11
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Tian X, Liu J, Li J, Jia W, Jiang P, Cheng Z, Zhang Y, Liu X, Zhou MI, Tian C. Removal of inferior vena cava filter by open surgery after failure of endovenous retrieval. Front Cardiovasc Med 2023; 10:1127886. [PMID: 37139130 PMCID: PMC10150111 DOI: 10.3389/fcvm.2023.1127886] [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: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background The permanent placement of inferior vena cava (IVC) filters may lead to numerous complications and their removal is recommended once the risk of pulmonary embolism is reduced. Removal of IVC filters by endovenous means is preferred. But failure of endovenous removal happens when recycling hooks penetrate the vein wall and filters are left in place for too long time. In these scenarios, open surgery may be effective for removal of IVC filters. We aimed to describe the surgical approach, outcomes, and 6-month follow-up of the removal of IVC filter by open surgery, after the failure of removal via the endovenous method. Methods A total of 1,285 patients with retrievable IVC filters were admitted from July 2019 to June 2021, including 1,176 (91.5%) endovenous filter removals, and 24 (1.9%) open surgical IVC filter removals after the failure by endovenous method, of whom 21 (1.6%) were followed-up and eligible for analysis of the study. Patient characteristics, filter type, filter removal rate, IVC patency rate, and complications were retrospectively analyzed. Results Twenty-one patients were left with IVC filters for 26 (10, 37) months, of which 17 (81.0%) patients had non-conical filters and 4 (19.0%) had conical filters; all 21 filters were successfully removed, with a 100% removal rate, no deaths, no serious complications, and no symptomatic pulmonary embolism. At the 3rd month follow-up after surgery and 3rd month follow-up after discontinuation of anticoagulation therapy, only 1 case (4.8%) had IVC occlusion, but without any occurrence of new lower limb deep venous thrombosis and silent pulmonary embolism. Conclusion Open surgery can be used for the removal of IVC filters after failure of removal by endovenous method or when accompanied by complications without symptoms of pulmonary embolism. Open surgical approach can be used as an adjunctive clinical intervention for the removal of such filters.
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12
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Tian X, Liu J, Li J, Liu X. Case report: Endoluminal removal of a retrievable conical inferior vena cava filter with a ruptured retraction hook attached to the wall. Front Surg 2022; 9:985060. [DOI: 10.3389/fsurg.2022.985060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
We report the case of a patient who underwent endovascular retrieval of a conical inferior vena cava (IVC) filter with a ruptured retraction hook that was attached to the IVC wall. A 21-year-old woman with a Celect (Cook) filter, implanted 1,522 days prior, requested retrieval. Preoperative ultrasound and CT examinations showed that the filter was inclined, the retraction hook was attached to the IVC wall, and one of the filter’s pedicles was broken. The inferior vena cava was patent, with no thrombus. Old superficial femoral vein thrombosis could be seen in the right lower extremity. The filter retrieval equipment (Gunther Tulip, Cook) failed to capture the retraction hook. By means of a pigtail catheter (with a partly removed catheter tip) and loach guidewire, we applied a modified loop-snare technique to successfully cut the proliferative tissue near the tip of the retraction hook, by which the hook re-entered the inferior vena cava. Although the snare successfully captured the retraction hook and retrieved the filter, the broken pedicle was retained in the inferior vena cava. We used forceps to capture and pull it to the distal end. In the end, the inferior vena cava became patent, with no contrast agent spillage or residual, and no symptomatic pulmonary embolization. A simultaneous occurrence of oblique adherence and fracture is rarely found in the same filter; however, by using the modified loop-snare technique and biopsy forceps technique, we successfully retrieved the filter and broken pedicle. Our case provides a practical auxiliary technique for regular clinical practice.
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13
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Abstract
Inferior vena cava filters are an important therapeutic option for patients with venous thromboembolism and contraindication to anticoagulation. Indications for filter placement have varied over the previous decades. This article discusses the history of inferior vena cava filter use, with a basic overview of technology and specific devices. Finally, this article reviews emerging filter design and technology. Understanding the basics of inferior vena cava filters is critical to building more robust clinical data for the purpose of improving patient outcomes.
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Affiliation(s)
- Brian Covello
- Department of Interventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
| | - Martin Radvany
- Department of Neurointerventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
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14
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Sheehan M, Coppin K, O'Brien C, McGrath A, Given M, Keeling A, Lee MJ. A single center 9-year experience in IVC filter retrieval - the importance of an IVC filter registry. CVIR Endovasc 2022; 5:15. [PMID: 35247104 PMCID: PMC8898204 DOI: 10.1186/s42155-022-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/24/2022] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate Inferior vena cava (IVC) filter retrieval practices over a 9-year period at an academic hospital with a prospectively maintained IVC filter registry. Method An IVC filter registry was maintained prospectively within our institution. We reviewed cases between August 2011 and June 2020, following filter status, retrieval plans, and eventual retrieval date. The validity of the database was cross referenced with a Picture Archiving and Communication System and patient records. Results Three hundred forty-three patients had IVC filters inserted. Three filter types were used, Celect (Cook Medical) in 189, Gunther Tulip (GT) (Cook Medical) in 65, ALN (ALN) in 89. 196 (57%) filters were retrieved, 108 (31.5%) were made permanent, 36 (10.5%) died before retrieval, and 3 (1%) were yet to be retrieved. Retrieval rates were 92.5% overall (86% for GT, 93% for Celect and 94.5% for ALN). The mean dwell time for successful retrieval was 59 days with the majority of insertions (85%) removed in under 100 days. Failed initial retrieval occurred in 23 patients, 10 (43%) were retrieved at second attempt, 13/23 filters remained in-situ and were deemed permanent. Conclusion The removal of IVC filters, when indication for insertion has past, is no longer the sole responsibility of the referring physician but also the responsibility of the Interventionalist. Our retrieval rates of 92.5% of eligible IVC filters highlights the value of maintaining a prospective IVC filter registry.
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Affiliation(s)
- Mark Sheehan
- Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Radiology, Beaumont Hospital, Dublin, Ireland.
| | - Kristopher Coppin
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Cormac O'Brien
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Andrew McGrath
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Aoife Keeling
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Michael J Lee
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin, Ireland
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15
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Rezaei-Kalantari K, Rotzinger DC, Qanadli SD. Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up. Front Cardiovasc Med 2022; 9:746748. [PMID: 35310979 PMCID: PMC8927289 DOI: 10.3389/fcvm.2022.746748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Mortality rates associated with venous thromboembolism (VTE) are high. Inferior vena cava filters (IVCFs) have been frequently placed for these patients as part of their treatment, albeit the paucity of data showing their ultimate efficacy and potential risk of complications. Issues regarding long-term filter dwell time are accounted for in society guidelines. This topic has led to an FDA mandate for filter retrieved as soon as protection from pulmonary embolism is no longer needed. However, even though most are retrievable, some were inadvertently left as permanent, which carries an incremental lifetime risk to the patient. In the past decade, attempts have aimed to determine the optimal time interval during which filter needs to be removed. In addition, distinct strategies have been implemented to boost retrieval rates. This review discusses current conflicts in indications, the not uncommon complications, the rationale and need for timely retrieval, and different quality improvement strategies to fulfill this aim.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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16
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Liu J, Jiang P, Tian X, Jia W, Huang NL, Zhan H, Chen W. Clinical outcomes of retrievable inferior vena cava filters for venous thromboembolic diseases. J Comp Eff Res 2022; 11:437-449. [PMID: 35199584 DOI: 10.2217/cer-2021-0291] [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: 11/21/2022] Open
Abstract
Aim: To identify literature evidence assessing retrievable inferior vena cava filter (rIVCF) for venous thromboembolic diseases. Methods: A systematic literature search was conducted to identify relevant references from the mainstay English and Chinese bibliographic databases (search period: January 2003 to October 2019). Results: 80 original studies with 11,413 patients were included in this review. The success rates of deploying the six types of rIVCFs ranged from 98.4 to 100.0%. Denali had the highest retrieval success rate (95.4-97.6%). The incidence rates of fracture and perforation associated with retrieving the six rIVCFs were less than 2%. Conclusion: The approved rIVCF had comparable clinical profiles, except that Denali was easier to be retrieved than other rIVCF.
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Affiliation(s)
| | - Peng Jiang
- Beijing Jishuitan Hospital, Beijing, China
| | - Xuan Tian
- Beijing Jishuitan Hospital, Beijing, China
| | - Wei Jia
- Beijing Jishuitan Hospital, Beijing, China
| | | | - Huan Zhan
- Changsha Normin Health Technology Ltd, Changsha, China
| | - Wendong Chen
- Changsha Normin Health Technology Ltd, Changsha, China.,Normin Health Consulting Ltd, Toronto, Canada
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17
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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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18
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Tian X, Liu J, Jia W, Jiang P, Cheng Z, Zhang Y, Li J, Tian C. Placing a New Filter before Removing Embolized Nonconical Filter: A Report of 13 Cases. Ann Vasc Surg 2021; 81:249-257. [PMID: 34775026 DOI: 10.1016/j.avsg.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Permanent filter placement may result in numerous complications. Filter removal is recommended if there are no risks of pulmonary embolism. This study aimed to explore the feasibility of placing a new filter when the embolized nonconical filter is removed. METHODS This study included patients who had received a new filter between 2018 and 2019 before the nonconical filters were removed. Patient characteristics, new filter types, thrombus interception rate, filter removal rate, feasibility, and safety were analyzed retrospectively. Feasibility was defined as the successful placement of new filters and the removal of the nonconical filters. Safety was defined as the absence of symptomatic pulmonary embolism and inferior vena cava hemorrhage after removing the nonconical filters, as well as the successful removal of new filters without symptomatic pulmonary embolism. RESULTS The average indwelling period of the nonconical filters was 29 (range, 17-30) days among the 13 patients. The removal rate of the nonconical filters was 100%. Five patients (38.5%) received new Denali filters, one (7.7%) received a new Celect filter, and 7 (53.8%) received new temporary filters. Thrombi were intercepted in 10 of the patients (76.9%). The removal rate of the replaced new filters was 100%. No rupture or shifting of the new filters occurred. No symptomatic pulmonary embolism was found after the removal of both the nonconical filters and the new filters. The patients were followed up for 3 months after the surgeries, and the inferior vena cavae of 12 (92.3%) patients were patent, and no new embolic events were found. CONCLUSIONS Placing a new replacement filter before removal of the embolized nonconical filter may be a feasible approach to prevent pulmonary embolism. Both the nonconical filter and the new filter could be removed subsequently after the thrombi were treated.
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Affiliation(s)
- Xuan Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jianlong Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China.
| | - Wei Jia
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Peng Jiang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Zhiyuan Cheng
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yunxin Zhang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jinyong Li
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Chenyang Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
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19
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Loh B, Liong R, Malacova E, Bain R. Risk factors associated with complex inferior vena cava filter retrievals and complications: A 7-year retrieval database analysis and the impact on retrieval rates at an Australian tertiary centre. J Med Imaging Radiat Oncol 2021; 65:875-882. [PMID: 34327831 DOI: 10.1111/1754-9485.13305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) affects approximately 17,000 Australians annually. While anticoagulation is the mainstay of treatment, inferior vena cava filters (IVCFs) are used in patients where this is contraindicated. The primary aim was to identify risk factors for complex retrievals and IVCF-related complications following the establishment of a database at a single tertiary centre. The secondary aim was to evaluate the IVCF retrieval rate and patients lost to follow-up. METHODS A retrospective study at a single tertiary centre was conducted on IVCFs inserted from 2012 to 2018. Logistic regression models were used to evaluate potential risk factors for filter-related complications and complex retrievals. RESULTS In total, 402 patients had an IVCF inserted. Of these, 308 patients (77%) had a retrieval attempted, 10 (3%) of which required more than one retrieval attempt (complex retrieval). Factors associated with filter-related complications included dwell time (OR 1.02, 95% CI: 1.01-1.04) and select indications for insertion, namely VTE requiring thrombolysis/thrombectomy (OR 2.29, 95% CI: 1.02-5.16) and iliocaval/free-floating iliofemoral DVT without thrombectomy/thrombolysis (OR 5.89, 95% CI: 1.53-22.71). After mutual adjustment for all variables, only dwell time remained a significant factor for filter-related complications (adjusted OR 1.03, 95% CI: 1.01-1.05) and complex retrieval (AOR 1.05, 95% CI: 1.02-1.08). The annual retrieval rate increased from 73% (2012) to 83% (2018), with an overall retrieval rate of 75%. CONCLUSION Dwell time is a potential risk factor for filter-related complications and complex retrievals. The annual IVCF retrieval rate was 75% since an Interventional Radiology-led database was established.
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Affiliation(s)
- Brendon Loh
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Rebecca Liong
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Bain
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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20
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Han K, Kim MD, Kim GM, Kwon JH, Lee J, Won JY, Moon S, An H. Comparison of Retrievability and Indwelling Complications of Celect and Denali Infrarenal Vena Cava Filters: A Randomized, Controlled Trial. Cardiovasc Intervent Radiol 2021; 44:1536-1542. [PMID: 34312689 DOI: 10.1007/s00270-021-02928-9] [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: 01/07/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the Celect and Denali filters in terms of complex filter retrieval and indwelling complications after a 2-month indwelling time. MATERIALS AND METHODS In this prospective, randomized trial, 153 subjects were assessed for eligibility between May 2016 and July 2018. A total of 136 participants were randomly assigned to receive either Celect (n = 68) or Denali (n = 68) filter placement in the infrarenal inferior vena cava. Tilt angles at placement and retrieval and rates of overall filter retrieval, indwelling complication, and complex retrieval were compared. RESULTS Of 136 participants (mean age, 62 ± 12.8 years, 55 male), 24 (17.6%) were lost to follow-up. The mean indwelling time of filter was 60.4 ± 7 days and there was no significant difference in the baseline characteristics between the two groups. Filter retrieval was successful in all participants (112/112, 100%). Significantly higher rates of filter tilt > 15° (n = 8) and strut penetration (n = 14) were found with the Celect filter than with the Denali filter (1 significant tilt and 1 penetration) (P = 0.033 and 0.001, respectively). No filter fractures were observed and there was no significant difference in tip embedment, filter fracture, filter migration, or mean fluoroscopy times. There were 3 cases of complex retrieval (1 for Denali vs. 2 for Celect, P = 0.500), for which the loop-snare technique was used. CONCLUSION Denali filters demonstrated significantly lower rates of tilt angle > 15° and strut penetration. However, there was no significant difference in the complex filter retrieval rate between the Celect and Denali filters.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sungmo Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Hyeongsu An
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
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21
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Kirkpatrick DL, Lindquist J, Jensen AM, Reghunathan A, Brown MA, Schramm KM, Ryu RK, Trivedi PS. Comparative efficacy and safety of the Captus device for inferior vena cava filter retrieval. Clin Imaging 2021; 77:202-206. [PMID: 33989965 DOI: 10.1016/j.clinimag.2021.04.024] [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: 11/23/2020] [Revised: 03/23/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Retrievable inferior vena cava filters (IVCF) have been increasingly used for mechanical pulmonary embolism prophylaxis since their development. The Captus Vascular Retrieval System (Avantec Vascular, Sunnyvale, California) is a new device developed for retrieval of IVCF. This study compared the safety and efficacy of the new Captus device against the existing EnSnare Endovascular Snare System (Merit Medical, South Jordan, Utah) for IVCF retrieval. METHODS Patients undergoing IVCF retrieval at a single institution between July 2015 and July 2020 were retrospectively identified. All adult patients (>18 years) undergoing filter retrieval with either Captus or Ensnare were included. Technical success and complications were compared by device. A complexity score was assigned to each case to adjust for selection bias. Logistic regression was used to model the association between device type and primary technical success. RESULTS 99 IVCF retrievals met inclusion criteria, 59 with Captus and 40 with Ensnare. The majority of the cohort consisted of low complexity cases (n = 51, 86% Captus versus n = 31, 78% Ensnare; p = 0.28). Technical success for low and medium complexity retrievals was 88% and 62% with Captus and 96% and 33% with Ensnare. There was no significant association between device type and technical success, adjusting for case complexity (Captus OR 0.55, 95% CI 0.08-2.72, p = 0.49). There were no device-related complications. CONCLUSION No statistically significant difference in device technical success or complications between the Ensnare and Captus devices for uncomplicated IVCF retrieval. PRECIS The Captus Vascular Retrieval System is a new device for IVC filter retrieval which has similar technical success to the existing EnSnare.
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Affiliation(s)
- Daniel L Kirkpatrick
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Jonathan Lindquist
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Alexandria M Jensen
- Department of Biostatistics, Colorado School of Public Health, Mail Stop # B119, 13001 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Arun Reghunathan
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Matthew A Brown
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Kristofer M Schramm
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Robert K Ryu
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
| | - Premal S Trivedi
- Department of Radiology, Division of Interventional Radiology, University of Colorado Anschutz Medical Campus, Mail Stop # L954, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America.
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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: 0.5] [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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Ribas J, Alba E, Pascual-González Y, Ruíz Y, Iriarte A, Mora-Luján JM, Valcárcel J, Corbella X, Santos S, Escalante E, Riera-Mestre A. Non-retrieved inferior vena cava filters: causes and long-term follow-up. Eur J Intern Med 2021; 86:73-78. [PMID: 33422388 DOI: 10.1016/j.ejim.2020.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Temporary inferior vena cava (IVC) filters are not always retrieved. Information about long-term outcomes of patients with indwelling filters is scarce. Aims of our study were to assess reasons that preclude retrieval of temporary IVC filters and long-term outcomes and causes of death in patients with indwelling filters. MATERIALS AND METHODS Retrospective observational study including all consecutive patients undergoing IVC filter insertion from January 2009 through December 2018. Patients with permanent filters and those with temporary filters not retrieved were followed from insertion until June 2020. RESULTS We included 271 patients with a mean age of 63.8 years. The main indication for filter insertion was acute venous thromboembolism and contraindication for anticoagulation (83%). The filter was deemed as permanent in 24.4% of patients and temporary in 75.6%. Sixty six percent of temporary filters were retrieved; the main cause of non-retrieval was lack of planning / follow-up (57.9%). One hundred twelve patients (41.3%) remained with indwelling filters. After follow-up, 54.5% were alive and 45.5% had died, with a median survival time of 6.19 (95% CI, 2.63-9.75) years. The most frequent cause of death during follow-up was cancer (49%). The frequency of anticoagulant therapy was similar in both groups (57.4%% versus 54.9%). CONCLUSIONS The main preventable cause of non-retrieval of temporary IVC filters was lack of planning / follow-up. Structured follow-up programs should be implemented to increase retrieval rates. In patients with indwelling filters, the main cause of death was cancer and extended anticoagulation was not associated with survival.
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Affiliation(s)
- Jesús Ribas
- Pneumology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Esther Alba
- Radiology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yuliana Pascual-González
- Pneumology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Ruíz
- Pneumology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Adriana Iriarte
- Internal Medicine, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José María Mora-Luján
- Internal Medicine, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joana Valcárcel
- Radiology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Internal Medicine, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Salud Santos
- Pneumology, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Elena Escalante
- Department of Radiology, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Antoni Riera-Mestre
- Internal Medicine, Hospital Universitari de Bellvitge - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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24
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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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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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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: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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De Gregorio MA, Guirola JA, Urbano J, Díaz-Lorenzo I, Muñoz JJ, Villacastin E, Lopez-Medina A, Figueredo AL, Guerrero J, Sierre S, Blazquez Sanchez J, Kuo WT, Jimenez D. Spanish multicenter real - life registry of retrievable vena cava filters (REFiVeC). CVIR Endovasc 2020; 3:26. [PMID: 32419040 PMCID: PMC7231811 DOI: 10.1186/s42155-020-00114-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The treatment of venous thromboembolic disease the treatment of choice is systemic anticoagulation. However, the interruption of the inferior vena cava with filters has been recommended when anticoagulation fails or there is a contraindication. Due to the rising inferior vena cava filter (IVCF) complications, physicians are encouraged to retrieve them when there is no longer recommended. In daily practice, it may be a difficult close follow-up of these patients. In this study, the primary objective was to evaluate the IVCF retrieval rate of all implanted filters in a Spanish registry. Secondary objectives were to analyze the causes of failed retrieval, procedure-related complications, and outcomes at a 12-month follow-up. RESULTS Three hundred fifty-six vena cava filters were implanted in 355 patients. The types of filter were: Gunther Tulip (Cook Medical) 160 (44.9%), Optease (Cordis) 77 (21.6%), Celect (Cook Medical) 49 (13, 7%), Aegisy (Lifetech Scientific) 33 (9.2%), Option ELITE (Argon Medical devices) 16 (4.4%), Denali filter (BD Bard) 11 (3.08%), ALN filter (ALN) 10 (2.8%). Removal was achieved in 274/356 (76,9%). eighty-two (23,1%) IVCF were not retrieved due to the following: 41 (11,5%) patients required ongoing filtration, 24 IVCF (6,7%) patients died before retrieval, and 17 (4,7%) impossibility of retrieval because of a tilted and embedded filter apex. There were no major complications observed. CONCLUSIONS The global retrieval rate of IVCF was achieved in 76.9%, and the adjusted retrieval rate was of 94.15% with no major complications. IVCF tilting was associated with failure of filter removal in less than 5% of cases. This study demonstrates that the retrieval procedure of IVCF is controlled by the clinician and not by the interventional radiologist.
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Affiliation(s)
| | - Jose A. Guirola
- Hospital Universitario Lozano Blesa, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | | | | | | | | | - Javier Guerrero
- Grupo Investigación Técnicas Mínimamente Invasivas (GITMI), Zaragoza, Spain
| | - Sergio Sierre
- Hospital Universitario Austral, Buenos Aires, Argentina
| | | | - William T. Kuo
- Department of Radiology, Stanford University Medical Center, Stanford, CA USA
| | - David Jimenez
- Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain
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28
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Casajuana E, Mellado M, Cebrià M, Marcos L, Calsina L, Paredes E, Monreal M, Clarà A. Changing trends in inferior vena cava filter indication for venous thromboembolism over the last two decades: a retrospective observational study. INT ANGIOL 2020; 39:276-283. [PMID: 32214069 DOI: 10.23736/s0392-9590.20.04326-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study aimed to evaluate changes in the incidence, patients' profile and indications of inferior vena cava filters at a single center over the past two decades. METHODS We retrospectively analyzed 187 consecutive patients with a venous thromboembolism requiring a filter at a tertiary hospital between 1999-2018. Within this period the availability of retrievable filters (since 2007) and the withdrawal of filter indication for recurrent venous thromboembolism from guidelines (since 2008) may have contributed to change practice patterns. Patients' profile, filter indication and survival were compared between decades (1999-2008 vs. 2009-2018). RESULTS The filter insertion rate doubled (60 vs. 127 cases) over 2009-2018. In this later period there was an unexpected rise (15 vs. 68 cases, P<0.001) of patients with isolated pulmonary embolism as baseline venous thromboembolism episode, without other relevant changes in patients' profile or survival. Regarding indications, there was an increase in filters for bleeding risk (23 vs. 45) and a reduction for venous thromboembolism recurrence (20 vs. 7), but also an unexpected increase of cases for bleeding (15 vs. 72). Among the 116 retrievable filters indicated for a temporary cause, 70 (60.3%) were finally not removed, being persistence of filter indication (n=33, 47.1%) the most common cause. CONCLUSIONS The number of filters inserted at our institution has raised over the last two decades. This increase was partly unexpected and perhaps related to the availability of retrievable filters. Unfortunately these devices remain frequently non-removed being persistence of the indication the most frequent cause.
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Affiliation(s)
- Eduard Casajuana
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Meritxell Mellado
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain.,Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Cebrià
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Lidia Marcos
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Laura Calsina
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Ezequiel Paredes
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Manuel Monreal
- Department of Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Albert Clarà
- Department Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain - .,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares, Barcelona, Spain
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Sotirchos VS, Trerotola SO, Stavropoulos SW. Magnification Spot Radiographs Improve Assessment for Inferior Vena Cava Filter Fractures prior to Removal Compared to CT. J Vasc Interv Radiol 2019; 31:61-65. [PMID: 31771893 DOI: 10.1016/j.jvir.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To determine if magnification spot radiographs acquired before attempting inferior vena cava (IVC) filter removal have value in the assessment for filter fractures. MATERIALS AND METHODS A retrospective review of complex IVC filter removals performed at a tertiary referral center from October 2015 to May 2017 was performed. Magnification spot radiographs (frontal and at least 2 oblique views) were obtained with the fluoroscopic unit in the procedure suite prior to venous access for filter removal. Patients were included in the study if a computed tomography (CT) scan of the abdomen/pelvis before filter removal was available. Ninety-six patients (47 women and 49 men) were included. Most removed filters were the Recovery/G2/G2X/Eclipse/Meridian (n = 28), the Günther Tulip (n = 26), and the Celect/Celect Platinum (n = 22). Blinded review of the pre-procedural CT scans and spot radiographs for the presence of filter fractures was performed by 2 interventional radiologists. Accuracy of each modality was assessed using the status of the explanted filter as the gold standard. Agreement between the 2 readers was assessed with the kappa statistic. RESULTS Fractures were present in 27 explanted filters (28%). Accuracy of CT was 88% and 68% for readers 1 and 2, respectively, which increased to 98% and 97% with magnification spot radiographs. The kappa statistic was 0.12 for CT and 0.97 for spot radiographs. CONCLUSIONS Magnification spot radiographs acquired before attempting IVC filter removal improve detection of filter fractures and agreement among interventional radiologists. Therefore, these should be performed routinely to allow for optimal treatment planning.
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Affiliation(s)
- Vlasios S Sotirchos
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St - 1 Silverstein, Philadelphia, PA, 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St - 1 Silverstein, Philadelphia, PA, 19104
| | - S William Stavropoulos
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St - 1 Silverstein, Philadelphia, PA, 19104.
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30
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Bowel Penetration by Inferior Vena Cava Filters: Feasibility and Safety of Percutaneous Retrieval. AJR Am J Roentgenol 2019; 213:1152-1156. [DOI: 10.2214/ajr.19.21279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Brahmandam A, Skrip L, Mojibian H, Aruny J, Sumpio B, Dardik A, Sarac T, Ochoa Chaar CI. Costs and complications of endovascular inferior vena cava filter retrieval. J Vasc Surg Venous Lymphat Disord 2019; 7:653-659.e1. [DOI: 10.1016/j.jvsv.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/23/2019] [Indexed: 10/26/2022]
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32
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Seifabadi R, Pritchard WF, Leonard S, Bakhutashvili I, Woods DL, Esparza-Trujillo JA, Karanian JW, Wood BJ. Feasibility and Acute Safety Study of Radiofrequency Energy Delivery to the Vena Caval Wall via an IVC Filter in Swine. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2019; 2:031005-1-031005-7. [PMID: 33134858 PMCID: PMC7595439 DOI: 10.1115/1.4043901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/06/2019] [Indexed: 06/11/2023]
Abstract
Retrievable inferior vena cava (IVC) filters are self-expanding metallic devices implanted in the IVC to prevent migration of thrombi from the deep veins of the legs and pelvis to the lungs. The risk of complications from the filters increases with duration of implantation, but retrieval may be difficult due to intimal hyperplasia around the components of the filter. In this study, the potential for delivery of radiofrequency (RF) energy to the IVC wall via the filter was investigated. IVC filters were deployed in 4 swine while attached to a snare connected to a 480 kHz RF generator. Energy ranging from 0 to 48 kJ was applied via the filter followed by re-sheathing and withdrawal of the filter while connected to a force measurement device. Resheathing forces for the 0-energy cohort and pooled data from the 6-24 kJ cohorts were 4.50±0.70 N and 4.50±0.75 N, respectively. Petechial hemorrhages and variable non-occlusive thrombi were noted in some cohorts including the 0-energy cohort, consistent with delivery and acute retrieval of an IVC filter. Histologically, the extent of RF-induced injury was subtle at 6 kJ with focal areas of homogenized collagen while the 12 kJ cohort showed segmental tissue charring with coagulation necrosis which was more extensive for the 24 kJ cohort. The 48 kJ energy caused more extensive and non-target organ damage. The study demonstrated feasibility of delivery of RF to the IVC wall via a deployed filter, supporting further study of the ability of local RF heating of the IVC wall to inhibit the neointimal hyperplasia or as an aid in retrieval.
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Affiliation(s)
| | | | - Shelby Leonard
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Ivane Bakhutashvili
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - David L. Woods
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Juan A. Esparza-Trujillo
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - John W. Karanian
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
| | - Bradford J. Wood
- Center for Interventional Oncology,
Radiology, and Imaging Sciences,
Clinical Center,
National Institutes of Health,
Bethesda, MD 20892
e-mail:
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Robbins JM, Garwe T, McCarthy CK, Sarwar Z, Gonzalez RA, Zander TL, Jalla AN, Conner KS, Stewart KE, Albrecht RM. Removal of retrievable inferior vena cava filters before discharge: Is it associated with increased incidence of pulmonary embolism? J Trauma Acute Care Surg 2019; 87:1113-1118. [PMID: 31166290 DOI: 10.1097/ta.0000000000002395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severely injured trauma patients are at high risk of developing deep venous thrombosis and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with deep venous thrombosis who cannot be anticoagulated. The removal rate of rIVCFs is variable in trauma centers, including our previous published rate of 50% to 89%/year. Indwelling filters carry a risk of significant morbidity and the success of retrieval decreases as the dwell time increases. We hypothesized that once patients could receive appropriate prophylactic or therapeutic anticoagulation, rIVCF could be removed before hospital discharge without impact on occurrence or recurrence of PE. METHODS All trauma patients with rIVCF placed and removed between January 2006 and August 2018 were reviewed. We collected data from record review from admission to 6 months postfilter removal, including demographics, filter indication, filter type, dwell time, placement and removal complications, antithrombosis medications, location of venous thromboembolism, complications, and discharge disposition. Exposure of interest was timing of filter removal: before (BEF) or after hospital discharge (AFT). The outcome of interest was whether the patient had a documented PE within 6 months of filter removal. RESULTS A total of 281 rIVCFs were placed, 218 were eligible for removal, 72.4% (158/218) were retrieved with 63% (100/158) removed before discharge. Mean filter duration was 26 days and 103 days for the before and after groups, respectively. No differences (p > 0.05) were noted in the distribution of demographic and clinical factors except for filter indication (venous thromboembolism indication, 95% in AFT vs. 74% in BEF, p = 0.0043). Postremoval PE rates were 0% BEF and 1% AFT (Fisher's exact test, p = 1.000). CONCLUSION Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates. LEVEL OF EVIDENCE Therapeutic, level V.
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Affiliation(s)
- Justin M Robbins
- From the College of Medicine (J.M.R., R.A.G., T.Z.), Department of Surgery (T.G., C.K.M., Z.S., A.N.J., K.S., R.M.A.), Department of Biostatistics and Epidemiology (T.G.), and Department of Radiology (K.S.C.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Kassamali RH, Burlak K, Lee JTL, Aberdein G, Harisis G, Goh GS, Kavnoudias H, Clements W. The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre. Cardiovasc Intervent Radiol 2019; 42:1110-1116. [DOI: 10.1007/s00270-019-02254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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Brahmandam A, Skrip L, Sumpio B, Indes J, Dardik A, Sarac T, Rectenwald J, Chaar CIO. A survey of vascular specialists' practice patterns of inferior vena cava filter placement and retrieval. Vascular 2018; 27:291-298. [PMID: 30501583 DOI: 10.1177/1708538118815394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The placement of inferior vena cava filters (IVCF) continues to rise. Vascular specialists adopt different practices based on local expertise. This study was performed to assess the attitudes of vascular specialists towards the placement and retrieval of IVCF. METHODS An online survey of 28 questions related to practice patterns regarding IVCF was administered to 1429 vascular specialists. Vascular specialists were categorized as low volume if they place less than three IVCF per month and high volume if they place at least three IVCF per month. The responses of high volume and low volume were compared using two-sample t-tests and Chi-square tests. RESULTS A total of 259 vascular specialists completed the survey (18% response rate). There were 191 vascular surgeons (74%) and 68 interventional radiologists (26%). The majority of responders were in academic practice (67%) and worked in tertiary care centers (73%). The retrievable IVCF of choice was Celect (27%) followed by Denali (20%). Forty-two percent used a temporary IVCF and left it in situ instead of using a permanent IVCF. Eighty-two percent preferred placing the tip of the IVCF at or just below the lowest renal vein. Thirty-one percent obtained a venous duplex of the lower extremities prior to retrieval while 24% did not do any imaging. There were 132 (51%) low volume vascular specialists and 127 (49%) high volume vascular specialists. Compared to low volume vascular specialists, significantly more high volume vascular specialists reported procedural times of less than 30 min for IVCF retrieval (57% vs. 42%, P = 0.026). There was a trend for high volume to have fewer unsuccessful attempts at IVCF retrieval but that did not reach statistical significance ( P = .061). High volume were more likely to have attempted multiple times to retrieve an IVCF (66% vs. 33%, P < .001), and to have used bronchoscopy forceps (32% vs. 14%, P = .001) or a laser sheath (14% vs. 2%, P < .001) for IVCF retrieval. In general, vascular specialists were not comfortable using bronchoscopy forceps (65%) or a laser sheath (82%) for IVCF retrieval. CONCLUSIONS This study underscores significant variability in vascular specialists practice patterns regarding IVCF. More studies and societal guidelines are needed to define best practices.
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Affiliation(s)
- Anand Brahmandam
- 1 Section of Vascular Surgery, Yale University School of Medicine, New Haven, USA
| | - Laura Skrip
- 2 National Public Health Institute of Liberia, Monrovia, Liberia
| | - Bauer Sumpio
- 1 Section of Vascular Surgery, Yale University School of Medicine, New Haven, USA
| | - Jeffrey Indes
- 3 Section of Vascular Surgery, Montefiore Medical Center, New York, USA
| | - Alan Dardik
- 1 Section of Vascular Surgery, Yale University School of Medicine, New Haven, USA
| | - Timur Sarac
- 4 Section of Vascular Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - John Rectenwald
- 5 Section of Vascular Surgery, University of Wisconsin, Madison, USA
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An analysis of factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval. Eur Radiol 2018; 29:1931-1938. [DOI: 10.1007/s00330-018-5766-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/21/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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de Gregorio MA, Guirola JA, Serrano C, Figueredo A, Kuo WT, Quezada CA, Jimenez D. Success in Optional Vena Cava Filter Retrieval. An Analysis of 246 Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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de Gregorio MA, Guirola JA, Serrano C, Figueredo A, Kuo WT, Quezada CA, Jimenez D. Success in Optional Vena Cava Filter Retrieval. An Analysis of 246 Patients. Arch Bronconeumol 2018; 54:371-377. [PMID: 29566970 DOI: 10.1016/j.arbres.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study assessed vena cava filter (VCF) retrieval rates and factors associated with retrieval failure in a single center cohort. METHODS We conducted an observational retrospective cohort study. The primary endpoint was the percentage of patients whose VCF was retrieved. We performed logistic regression to identify variables associated with retrieval failure. RESULTS During the study period, 246 patients received a VCF and met the eligibility requirements to be included in the study; 151 (61%) patients received a VCF due to contraindication to anticoagulation, 69 (28%) patients had venous thromboembolism (VTE) and a high risk of recurrence, and 26 (11%) patients received a filter due to recurrent VTE while on anticoagulant therapy. Of 236 patients who survived the first month after diagnosis of VTE, VCF was retrieved in 96%. Retrieval rates were significantly lower for patients with recurrent VTE while on anticoagulation, compared with patients with contraindication to anticoagulation or patients with a high risk of recurrence (79% vs. 97% vs. 100%, respectively; P<0.01). Mean time to retrieval attempt was significantly associated with retrieval failure (137.8 ± 65.3 vs. 46.3 ± 123.1 days, P<0.001). CONCLUSIONS In this single center study, VCF retrieval success was 96%. A delay in the attempt to retrieve the VCF correlated significantly with retrieval failure.
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Affiliation(s)
- Miguel A de Gregorio
- Grupo de Investigación en Técnicas Mínimamente Invasivas (GITMI), Universidad de Zaragoza, Hospital Clínico Lozano Blesa, Zaragoza, España; Servicio de Neumología, Hospital Miguel Servet, Zaragoza, España
| | - José A Guirola
- Grupo de Investigación en Técnicas Mínimamente Invasivas (GITMI), Universidad de Zaragoza, Hospital Clínico Lozano Blesa, Zaragoza, España; Servicio de Neumología, Hospital Miguel Servet, Zaragoza, España
| | - Carol Serrano
- Grupo de Investigación en Técnicas Mínimamente Invasivas (GITMI), Universidad de Zaragoza, Hospital Clínico Lozano Blesa, Zaragoza, España; Servicio de Neumología, Hospital Miguel Servet, Zaragoza, España
| | - Ana Figueredo
- Grupo de Investigación en Técnicas Mínimamente Invasivas (GITMI), Universidad de Zaragoza, Hospital Clínico Lozano Blesa, Zaragoza, España; Servicio de Neumología, Hospital Miguel Servet, Zaragoza, España
| | - Willian T Kuo
- Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, Standford, CA, United States
| | - Carlos Andrés Quezada
- Servicio de Neumología, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Alcalá de Henares, España
| | - David Jimenez
- Servicio de Neumología, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Alcalá de Henares, España.
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Calleja E, Ciampi JJ, Puche JJ, Lanciego C. Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy. RADIOLOGIA 2018; 60:517-520. [PMID: 29685553 DOI: 10.1016/j.rx.2018.02.011] [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: 09/28/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 11/18/2022]
Abstract
We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.
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Affiliation(s)
- E Calleja
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
| | - J J Ciampi
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - J J Puche
- Unidad de Corta Estancia de Medicina Interna, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - C Lanciego
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
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Power JR, Nakazawa KR, Vouyouka AG, Faries PL, Egorova NN. Trends in vena cava filter insertions and "prophylactic" use. J Vasc Surg Venous Lymphat Disord 2018; 6:592-598.e6. [PMID: 29678686 DOI: 10.1016/j.jvsv.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prophylactic vena cava filter (VCF) use in patients without venous thromboembolism is common practice despite ongoing controversy. Thorough analysis of the evolution of this practice is lacking. We describe trends in VCF use and identify events associated with changes in practice. METHODS Using the National Inpatient Sample, we conducted a retrospective observational study of U.S. adult hospitalizations from 2000 to 2014. Trends in prophylactic VCF insertion were analyzed both across the entire study population and within subgroups according to trauma status and type of concurrent surgery. Annual percentage change (APC) was calculated, and trends were analyzed using Poisson regression. RESULTS Among 461,904,314 adult inpatients (median [interquartile range] age, 58.1 [38.5-74.3] years; 39.6% male), the incidence of VCF insertion increased rapidly at first (from 0.19% to 0.35%; APC, 11.2%; 95% confidence interval [CI], 10.3%-12.2%; P < .001), then at a slower rate after the publication of the Prévention du Risque d'Embolie Pulmonaire par Interruption Cave 2 (PREPIC2) trial in 2005 (from 0.35% to 0.42%; APC, 4.4%; 95% CI, 2.8%-6.0%; P < .001), and it began decreasing after the 2010 Food and Drug Administration (FDA) safety alert (from 0.42% to 0.32%; APC, -5.5%; 95% CI, -6.5% to -4.6%; P < .001). The percentage of total VCFs that had a prophylactic indication increased quickly before publication of the PREPIC2 trial (APC, 19.5%; 95% CI, 17.9%-21.0%; P < .001), increased at a slower rate after publication in 2005 (APC, 4.4%; 95% CI, 2.6%-6.2%; P < .001), and dropped after the FDA safety alert, stabilizing at 18.5% for the last 3 years (APC, -0.3%; 95% CI, -2.2% to 1.7%; P = .8). Subgroups most associated with prophylactic VCF insertion were operative trauma (odds ratio [OR], 10.9; 95% CI, 10.2-11.7), orthopedic surgery (OR, 4.7; 95% CI, 4.3-5.2), and neurosurgical procedures (OR, 3.9; 95% CI, 3.6-4.2). All groups except orthopedic surgery experienced a deceleration in prophylactic VCF growth after the publication of PREPIC2. Meanwhile, the FDA safety alert was associated with a decrease in prophylactic VCF insertions for all groups except other major surgery. CONCLUSIONS Whereas publication of the PREPIC2 trial led to a deceleration in prophylactic VCF insertion growth, the FDA alert had a bigger impact, leading to declining rates of prophylactic VCF use. Further investigations of prophylactic insertion of VCF in trauma, orthopedic, and neurosurgical patients are needed to determine whether current levels of use are justified.
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Affiliation(s)
- John R Power
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth R Nakazawa
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ageliki G Vouyouka
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter L Faries
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
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Jia Z, Fuller TA, McKinney JM, Paz-Fumagalli R, Frey GT, Sella DM, Van Ha T, Wang W. Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications. Cardiovasc Intervent Radiol 2018; 41:675-682. [PMID: 29359241 DOI: 10.1007/s00270-018-1880-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval. METHODS A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016. RESULTS A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n = 6270; 56.3%) and prophylactic (n = 4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6 ± 47.3 days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively. CONCLUSIONS Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.
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Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, China
| | - Tyler A Fuller
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, 34211, USA
| | - J Mark McKinney
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ricardo Paz-Fumagalli
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Gregory T Frey
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David M Sella
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Tse G, Cleveland T, Goode S. Ten-year experience of retrievable inferior vena cava filters in a tertiary referral center. Diagn Interv Radiol 2017; 23:144-149. [PMID: 28093377 DOI: 10.5152/dir.2016.16022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed. METHODS Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital. Results of all clinical investigations (including computed tomography, magnetic resonance imaging, ultrasonography, and plain radiography) while the IVC filters were in situ were reviewed. RESULTS In total, 393 retrievable IVC filters were inserted, 254 with the indication of preoperative thromboembolic prophylaxis. Recurrent PE was reported in five patients (1.9%) despite the IVC filter. Of the 254 retrievable filters inserted prior to surgery, an attempt at retrieval was made in 168 filters (66.1%). Successful retrieval at the first attempt occurred in 143 cases (85.1%), while 25 cases failed or were aborted (14.9%). No attempt at retrieval was made in 86 (33.9%) patients and a significant proportion of these patients had undergone cancer surgery (P < 0.0107). In those patients where there was no attempt at retrieval, there was an association between cancer surgery and a shorter absolute survival time (P < 0.0001). CONCLUSION The majority of attempted filter retrievals were successful, and a proportion of nonretrieved IVC filters are accounted for in patients who underwent cancer surgery and ultimately died with the filter in situ. A departmental protocol is recommended to ensure the filter is removed where appropriate and possible.
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Affiliation(s)
- George Tse
- Department of Radiology, Northern General Hospital, Sheffield, UK.
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Taslakian B, Chawala D, Sista AK. A Survey of Submassive Pulmonary Embolism Treatment Preferences among Medical and Endovascular Physicians. J Vasc Interv Radiol 2017; 28:1693-1699.e2. [PMID: 28802551 DOI: 10.1016/j.jvir.2017.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine treatment preferences among endovascular and medical physicians who manage acute submassive pulmonary embolism (PE). MATERIALS AND METHODS From July through August 2016, 83 sites across the United States were surveyed, and 60 completed the survey. Endovascular and medical physicians were asked to rate their predilection for catheter-directed thrombolysis (CDT) on a 5-point scale and for systemic thrombolysis (ST) as "yes" or "no" in seven case scenarios of submassive PE. A CDT score ≥ 4 was considered to represent a predilection for CDT. Mean scores were used to compare CDT preferences between physicians. Percentages of physicians who preferred CDT or ST were calculated. P values < .05 were considered statistically significant. RESULTS Across all scenarios (numbered S1-S7) combined, endovascular physicians had a significantly higher CDT score (mean, 3.52) than medical physicians (mean, 3.01; P < .0001). Scenario-by-scenario analysis revealed that the mean CDT score was significantly higher for endovascular physicians (S1, 4.25; S2, 3.72; S3, 2.82; S4, 2.68; S5, 3.45; S6, 3.67; S7, 4.02) compared with medical physicians (S1, 3.62 [P < .001]; S2, 3.18 [P < .001]; S3, 2.45 [P = .001]; S4, 2.37 [P = .011]; S5, 2.97 [P < .001]; S6, 3.20 [P < .001]; S7, 3.53 [P < .001]). Overall, a significantly higher percentage of endovascular physicians (56.7%) indicated a predilection for CDT compared with medical physicians (37.9%; P < .001). Also, a significantly higher percentage of physicians, regardless of specialty, indicated a predilection for CDT (47.2%) than did for ST (5.3%; P < .0001). CONCLUSIONS Endovascular physicians exhibited a greater predilection for CDT to treat acute submassive PE compared with their medical colleagues. Endovascular and medical physicians seemed to more frequently choose CDT than ST.
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Affiliation(s)
- Bedros Taslakian
- Department of Radiology, New York University Langone Medical Center, 660 First Ave., 3rd Floor, New York, NY 10016
| | - Daanish Chawala
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Akhilesh K Sista
- Department of Radiology, New York University Langone Medical Center, 660 First Ave., 3rd Floor, New York, NY 10016.
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De Gregorio MA, Guirola JA, Lahuerta C, Serrano C, Figueredo AL, Kuo WT. Interventional radiology treatment for pulmonary embolism. World J Radiol 2017; 9:295-303. [PMID: 28794825 PMCID: PMC5529318 DOI: 10.4329/wjr.v9.i7.295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.
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Abstract
Use of inferior vena cava (IVC) filters has increased dramatically in recent decades, despite a lack of evidence that their use has impacted venous thromboembolism (VTE)-related mortality. This increased use appears to be primarily driven by the insertion of retrievable filters for prophylactic indications. A growing body of evidence, however, suggests that IVC filters are frequently associated with clinically important adverse events, prompting a closer look at their role. We sought to narratively review the current evidence on the efficacy and safety of IVC filter placements. Inferior vena cava filters remain the only treatment option for patients with an acute (within 2-4 weeks) proximal deep vein thrombosis (DVT) or pulmonary embolism and an absolute contraindication to anticoagulation. In such patients, anticoagulation should be resumed and IVC filters removed as soon as the contraindication has passed. For all other indications, there is insufficient evidence to support the use of IVC filters and high-quality trials are required. In patients where an IVC filter remains, regular follow-up to reassess removal and screen for filter-related complications should occur.
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Affiliation(s)
- L Duffett
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - M Carrier
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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COUNTERPOINT: Do the Benefits Outweigh the Risks for Most Patients Under Consideration for Inferior Vena Cava Filters? No. Chest 2016; 150:1182-1184. [DOI: 10.1016/j.chest.2016.08.1477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022] Open
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Ryan E, Kok HK, Lee MJ. Retrievable IVC filters - Friend or foe. Surgeon 2016; 15:104-108. [PMID: 27520332 DOI: 10.1016/j.surge.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 01/09/2023]
Abstract
Venous thromboembolism is a common condition with widely varied outcomes. Pulmonary embolism is associated with a case-fatality rate of up to 8%, increasing up to 18-fold in massive PE. Pharmacological treatment of VTE with anticoagulant medication (AC) is the first line therapy of choice. Retrievable inferior vena cava filters (IVCF) are indicated as a short-term replacement for AC in certain circumstances. Most of the evidence concerning IVCF pertains to permanent filters and older filter models. Limited evidence for retrievable IVCF results in poor consensus regarding indications, follow-up and retrieval. Complications increase with dwell-time and retrieval success rates decline. Professional bodies advocate strict guideline adherence and robust strategies for filter monitoring to maximise retrieval rate.
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Affiliation(s)
- E Ryan
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland
| | - H K Kok
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland
| | - M J Lee
- Department of Imaging and Interventional Radiology, Royal College of Surgeons and Beaumont Hospital, Ireland.
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Ghatan CE, Ryu RK. Permanent versus Retrievable Inferior Vena Cava Filters: Rethinking the "One-Filter-for-All" Approach to Mechanical Thromboembolic Prophylaxis. Semin Intervent Radiol 2016; 33:75-8. [PMID: 27247474 DOI: 10.1055/s-0036-1582123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Inferior vena cava (IVC) filtration for thromboembolic protection is not without risks, and there are important differences among commercially available IVC filters. While retrievable filters are approved for permanent implantation, they may be associated with higher device-related complications in the long term when compared with permanent filters. Prospective patient selection in determining which patients might be better served by permanent or retrievable filter devices is central to resource optimization, in addition to improved clinical follow-up and a concerted effort to retrieve filters when no longer needed. This article highlights the differences between permanent and retrievable devices, describes the interplay between these differences and the clinical indications for IVC filtration, advises against a "one-filter-for-all" approach to mechanical thromboembolic prophylaxis, and discusses strategies for optimizing personalized device selection.
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Affiliation(s)
- Christine E Ghatan
- Department of Radiology, University of Colorado Denver, Aurora, Colorado
| | - Robert K Ryu
- Department of Radiology, University of Colorado Denver, Aurora, Colorado
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Observations on failed retrieval of optional inferior vena cava filters. Clin Imaging 2016; 40:931-5. [PMID: 27196734 DOI: 10.1016/j.clinimag.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate causes of failed optional inferior vena cava filter (IVCF) retrievals. METHODS Single-center retrospective study. RESULTS IVCF retrievals were attempted in 26/211 (12%) patients at a mean 42.9 days. There were 9 failures (all OptEase) due to: inability to snare the hook (n=5), noncollapsible IVCF (n=3), and unusual procedural pain (n=1). Median duration of retrieved IVCFs was 31 days compared to 53 days for failures (P<.05). IVCFs aligned with the IVC's cephalocaudal axis were retrieved in 13/16 cases, while misaligned IVCFs were retrieved 4/10 cases (P<.05). CONCLUSION Filter duration and misalignment were significantly associated with retrieval failures.
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