Endovascular Intervention Reduces Thrombosis Risk in Retrievable Inferior Vena Cava Filters: A Multicenter Propensity-Matched Analysis.

Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters

Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism

Efficacy of Retrievable Inferior Vena Cava Filter Placement in the Prevention of Pulmonary Embolism during Catheter-Directed Thrombectomy for Proximal Lower-Extremity Deep Vein Thrombosis

To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%-90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12-25months of follow-up, iliac vein stents and lower extremity veins maintained patent. The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.

Purpose: Up to now, the indications of inferior vena cava filter placement still remain controversial in the academic field. The aim of this study was to determine the risk factors of detachment of thrombus and to evaluate the necessity of inferior vena cava filter placement to prevent fatal pulmonary embolism. Materials and Methods: A total of 2892 patients participated in the multicenter prospective observational study from January 1, 2018, to December 31, 2018, and underwent retrievable inferior vena cava filter (RIVCF) placement in 103 centers in China. The primary endpoint of the study was RIVCF trapped embolus detected by inferior vena cava venography/ultrasound/computed tomography scanning or visible macroscopic thrombus before or during RIVCF retrieval. The relative factors of RIVCF trapped embolus were analyzed accordingly. Results: The average age of the patients was 61.0 (50.0-71.0) years. Retrievable inferior vena cava filter trapped embolus occurred in 308 patients (10.65%). The fracture location, surgery location, and endovascular intervention differed between RIVCF trapped embolus and non-RIVCF trapped embolus groups (p<0.001, respectively). By multivariate analysis, RIVCF trapped embolus were less common in older patients (odds ratio [OR]=0.998; p<0.001) and more common in patients with below-the-knee fracture (OR=1.093, p=0.038), thigh fracture (OR=1.118, p=0.007), and pelvis surgery (OR=1.067, p=0.016). In addition, compared with patients without endovascular intervention, patients with percutaneous mechanical thrombectomy (PMT) + catheter-directed thrombolysis (CDT) were more prone to develop RIVCF trapped embolus (OR=1.060, p=0.010). However, RIVCF trapped embolus was less common in patients with CDT (OR=0.961, p=0.004). Conclusions: Lower limb fracture, pelvis surgery, and PMT + CDT are prone to cause trapped embolus. As a trapped embolus often represents the possibility of severe pulmonary embolism, lower limb fracture, pelvis surgery, and PMT + CDT could be risk factors of fatal pulmonary embolism. Due to the low incidence of trapped embolus, it is not necessary to place filters in elderly patients and CDT-only patients. Clinical Impact The purpose of this paper is to standardize the use of inferior vena cava filter and avoid unnecessary filter implantation through the summary and analysis of a large number of clinical data. At the same time, more attention should be paid to and active treatment should be given to high-risk groups of pulmonary embolism.

Background:Pulmonary embolus (PE) secondary to deep vein thrombosis (DVT) continues to be a major source of morbidity and mortality in trauma populations. Patients with cervical spinal cord injury (SCI) are particularly susceptible to developing this complication. Non-invasive methods of preventing SCI, such as lower extremity compression devices and anticoagulation, do not confer complete protection against DVT. Retrievable inferior vena cava filters (IVCFs) offer the advantage of both providing protection against PE and avoidance of long-term complications such as DVT, if removed in a timely fashion. Our goals in this study were to identify complications related to IVCF insertion and also to determine if prophylactic insertion of IVCF is effective in preventing PE in spinal cord injured patients.Methods:This was a retrospective single center study that involved cervical SCI patients who were admitted to Parkview Hospital, a level II trauma center, from January 2003 to December 2009 and underwent placement of a prophylactic IVCF within 72 hours of admission. Patients were identified from a prospectively maintained trauma registry.Results:During a 6-year period, 45 spinal cord injured patients were identified, who underwent placement of a prophylactic IVCF. There were 37 men and 8 women. There were no short-term complications associated with peripheral intravenous catheter (PIVC) insertion. Seventeen of the 45 (37%) patients underwent successful removal of the filter within 6–8 weeks of insertion. Twenty patients did not return for removal during the 6–8 week period for removal and eight patients were lost to follow-up. None of the patients who underwent prophylactic IVCF placement sustained a PE.Conclusion:Our results suggest that the use of retrievable prophylactic IVCF is a safe procedure and has the added benefit of preventing the long-term lower extremity thrombotic complications associated with their use. Even though none of the patients sustained a PE, definitive conclusions regarding the efficacy of IVCF in preventing PE could not be made due to the small sample size of our study.

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

Inferior Vena Cava Filter Placement and Retrieval Rates among Radiologists and Nonradiologists

Case report on the non-operative management of a retrievable inferior vena cava filter perforating the duodenum

Pulmonary embolus (PE) is a potentially devastating and fatal postoperative complication in morbidly obese patients. This study was undertaken to review the safety and efficacy of retrievable prophylactic inferior vena cava (IVC) filters in high-risk morbidly obese patients undergoing gastric bypass. Patients who underwent gastric bypass surgery and preoperative insertion of retrievable IVC filters had their records reviewed. Indications for IVC filter insertion were: history of deep venous thrombosis (DVT) or PE, long-standing sleep apnea, venous stasis disease, and/or weight > 400 pounds. 24 patients underwent IVC filter placement before gastric bypass surgery. There were 10 women and 14 men with an average age of 50 +/- 6.3 years (range 39 to 59) and average body mass index (BMI) of 57 +/- 7.5 kg/m(2) (range 49 to 74). BMI greater then 50 kg/m(2) was present in 21 of 24 patients (88%). All patients had successful IVC filter placement. IVC filter retrieval postoperatively was performed in 20 of 24 patients (83%) with three left for clinical reasons and one (4%) left due to technical inability to retrieve. There was one complication directly attributable to IVC filter retrieval. There were no deaths. Five patients (21%) developed DVT or PE postoperatively. Follow-up was 16 +/- 7.6 months (range 8 to 33). Prophylactic IVC filter placement and retrieval can be safely undertaken in high-risk gastric bypass patients. We recommend preoperative IVC filter placement in selected patients.

A RARE INSTANCE OF AN INFERIOR VENA CAVA FILTER FAILING TO PREVENT RECURRENT PULMONARY EMBOLISM

1:57 PM Abstract No. 178 - Effectiveness and complications of routine and advanced inferior vena cava filter retrieval techniques

Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal

To evaluate the clinical features, diagnostic methods and treatment of venous thromboembolic disease (VTE) during pregnancy. From June 2006 to June 2011, a total of 20 pregnant women were diagnosed VTE at the Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University. Clinical data of these patients were analyzed retrospectively. (1) Characteristics of patients:the symptoms of all the 20 patients commenced in pregnancy. Of these, 6(30%) happened in the first trimester, 7 (35%) in the second trimester, and 7 (35%) in the third trimester. Twelve (60%) patients went to hospital in one week after they had symptoms, while 8 (40%) went to hospital after one week. (2) Clinical manifestation: 18 patients were diagnosed deep venous thrombosis (DVT), one was diagnosed pulmonary embolism (PE). One patient was diagnosed DVT and PE simultaneously. Among the 19 DVT patients, 16 (16/19)were on the left side, 3(3/19)were on the other. They all came with sudden swelling and pain of the affected lower extremity. In 17 (17/19) patients, the circumference differences between two legs were beyond (4.0 ± 0.5) cm. In all the 20 patients, 12(60%) had elevated plasma level of D-dimmer. The diagnosis of DVT was made mainly by a Doppler ultrasound. Among the 19 DVT events, 7 (7/19) were proximal DVT, 2 (2/19) were distal, and 10(10/19) were mixed type. (3) Anticoagulant therapy: patients with VTE during pregnancy were treated with low molecular weight heparin (LMWH) (enoxaparin, once 1 mg/kg subcutaneous, twice a day). After delivery, patients were treated with subcutaneous LMWH and warfarin simultaneously for at least 5 days, until the prothrombin time-international normalized ratio (PT-INR) was > 2.0 for 24 hours. (4) Thrombolytic therapy: for most patients with VTE, we are against the routine use of thrombolytic therapy, especially before delivery. For patients with acute massive PE, urokinase of 600 000 units intravenously daily was recommended for 3 days. For those patients with DVT whose standard anticoagulation therapy was < 30 days, an inferior vena cava filter (IVCF) placement was recommended before delivery or abortion. If it was ≥ 30 days, IVCF was not recommended as a routine, and anticoagulant therapy was used 24 hours after delivery. If there was no recurrent DVT or PE, IVCF was retrieved routinely in 12 days. (5) OUTCOME: among patients treated with LMWH (95%, 19/20). Three received IVCF placement, which was retrieved successfully in 12 days, with no interventional complication. All patients recovered well after 2 weeks, and the circumference differences between two legs were within (2.0 ± 0.3) cm. Of the 18 patients maintained to the third trimester, 17 received anticoagulant therapy, and no abnormal findings were found during antenatal examination. Ten patients received cesarean section (50%, 10/20), while 8 had vaginal delivery (40%, 8/20). Neither neonatal asphyxia nor malformation was observed. The patients were followed-up for 1 - 24 months, no venous thrombus extension was found in 17 cases by Doppler ultrasound, thrombus disappeared in 2 cases of distal DVT after 4 weeks and 8 weeks respectively. By echocardiography, the pulmonary arterial pressure of the 2 patients with PE was found normal 3 months after hospital discharge. There was no maternal death during the study, no recurrent PE or bleeding occured. LMWH is safe and effective for VTE during pregnancy. Routine use of thrombolytic therapy is not recommended. VTE in pregnancy is not the absolute indication of termination of pregnancy. The indication of an IVCF placement should be stricter, and a retrievable suprarenal IVCF is recommended under certain circumstances.

Background The ideal thromboprophylaxis in patients at risk of bleeding is uncertain. This retrospective cohort study assessed the risk factors for complications after using retrievable inferior vena cava (IVC) filters for primary or secondary thromboembolism prophylaxis in patients after major trauma. Methods Using data from radiology, trauma and death registries, the incidence of and risk factors for subsequent deep venous thrombosis (DVT), venous thromboembolism (VTE), and mechanical complications related to retrievable IVC filters in patients, admitted between 2007 and 2012, were assessed in a single trauma centre. Results Of the 2940 major trauma patients admitted during the study period, a retrievable IVC filter was used in 223 patients (7.6%). Thirty-six patients (16%) developed DVT or VTE subsequent to placement of IVC filters (median 20 days, interquartile range 9-33), including 27 with lower limb (DVT), 8 upper limb DVT, and 4 pulmonary embolism. A high Injury Severity Score, tibial/fibular fractures, and a delay in initiating pharmacological thromboprophylaxis after insertion of the filters (14 vs 7 days, P=0.001) were significant risk factors. Thirty patients were lost to follow-up (13%) and their filters were not retrieved. Mechanical complications - including filters adherent to the wall of IVC (4.9%), IVC thrombus (4.0%), and displaced or tilted filters (2.2%) - were common when the filters were left in situ for >50 days. Conclusions A delay in initiating pharmacological thromboprophylaxis or filter removal were associated with an increased risk of subsequent DVT, VTE, and mechanical complications of retrievable IVC filters in patients after major trauma.