Retrievable inferior vena cava filters may be safely applied in gastric bypass surgery

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

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

Permanent Inferior Vena Cava Filters Offer Greater Expected Patient Utility at Lower Predicted Cost

To the Editor: Retrievable inferior vena cava (IVC) filter placement has been on the rise over the years, but only a small percentage of retrievable IVC filters have been removed, ranging between 10.1% and 38.9%.[12] Laparoscopic retrieval of IVC filter case report was available since 2015,[3] the filter hook in the case report was seen clearly protruding from the anterior wall of the cava, and there was no need for vena cavotomy and reconstruction. In this case, the IVC filter tip was embedded in the posterior wall and cavotomy was required. Very few studies have reported the laparoscopic IVC filter retrieval through vena cavotomy and reconstruction. A 32-year-old woman presented to our hospital with the history of deep venous thrombosis (DVT) in his right lower extremity. Approximately 2 years before, the patient had a retrievable IVC filter (Cook Celect, COOK MEDICAL, USA) placed in a local hospital due to the right lower leg DVT which happened during her pregnancy. Two separate attempts aimed to remove the filter were unsuccessful, abdominal computed tomography showed the filter tilted and struts of the filter penetrating the caval wall appeared to be outside the IVC [Figure 1a]. Considering the patient's young age and long-term filter-associated complications, decision was made to remove the filter by laparoscopic surgery.Figure 1: (a) Abdomen computed tomography showing the filter legs penetrating through the cava, abutting the abdominal aorta (arrow). (b) The vessel loops wrapped around the inferior vena cava above and below the filter. (c) Use of the wire loop and snare technique for the retrieval of the embedded filter.The operation was performed under general anesthesia. The colon and duodenum were mobilized and retracted to the left, and then the IVC was identified. The gonadal vein and the lumbar veins were ligated with Hem-o-lok clips (Teleflex, Wayne, PA, USA). Vascular control was obtained proximal and distal to the filter. The infrarenal IVC is encircled with a tourniquet, the tourniquet passed through a half-inch piece of 20-F drain catheter and secured in place with a Hem-o-lok clip [Figure 1b]. After alerting the anesthesiologist, the two tourniquets were tightly cinched sequentially (distal and proximal); the cavotomy was performed at the apex of the IVC filter to simplify grasp of the filter tip and to collapse the filter legs. A scissor was necessary to separate the filter tip as it was discovered that the filter tip was embedded in the wall of the IVC. Using a loop snare, the filter hook was engaged and the filter was retracted into a filter-removing sheath [Figure 1c]. Cavotomy was closed using the 5-0 running prolene sutures. The tourniquets were released to restore the caval flow. The patient recovered well from the surgery. Although IVC filters reduce risks of pulmonary embolism, there are filter-related complications such as IVC perforation, penetration of adjacent viscera, and filter fracture.[45] Several techniques for retrievals have been described previously,[5] but some filters are still difficult to be retrieved. When endovascular removal is not possible, filters can be removed by the surgical approach, either open or laparoscopic. The open surgery is more invasive. The laparoscopic approach is suitable for patients with the filter tip well outside the IVC and protruding anteriorly.[3] For the filter tip protruding posteriorly, or embedded in the cava wall like in this case, laparoscopic surgery would be challenging. The major risk of the laparoscopic approach is either significant blood loss or CO2 embolism due to IVC tear. In either situation, immediate transition to an open surgery and transfusion is critical. Fortunately, surgery described in this case went well. In conclusion, laparoscopic retrieval of IVC filters is a complex and technically demanding surgery. Careful preoperative preparation, operative experiences, and proficient skills might improve the safety and success rate of operation. Declaration of patient consent The authors certify that they have obtained the patient consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely. To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy. A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England. In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records. Placement of retrievable IVC filter. In total, 952 medical records were included in the analysis. Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy. Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.

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

A retrospective data analysis. To report a comprehensive assessment of preoperative prophylactic inferior vena cava (IVC) filter placement in spine surgery. Venous thromboembolism (VTE) is a serious complication after major spinal reconstructive surgery in adults. Specifically, pulmonary embolism (PE) can result in significant morbidity and mortality, and it has been reported in up to 13% of patients. Prophylactic IVC filter placement was initiated for all "high-risk" spinal surgery patients after a pilot study demonstrated decreased VTE-related morbidity and mortality. After institutional review board approval, the medical records of all patients receiving an IVC filter at a single institution from 2000 to 2007 were reviewed. Age, sex, surgical approach, postoperative deep vein thrombosis (DVT), postoperative superficial thrombus, presence of pulmonary or paradoxical embolus, mortality, and IVC filter complications were all evaluated. Indications for IVC filter placement included history of DVT or PE, malignancy, hypercoagulability, prolonged immobilization, staged procedures of longer than 5 segment levels, combined anterior-posterior approaches, iliocaval manipulation during exposure, and anesthetic time of more than 8 hours. Descriptive statistics were used for the analysis of patient characteristics. Nonparametric frequency statistics (odds ratios [OR], χ) were used for analysis of main outcomes. A total of 219 patients (150 women, 69 men) with a mean age of 58.8 (range, 17-86) years, were analyzed. There were 2 complications from IVC filter placement (66 Greenfield filters; 157 retrievable filters). The incidence of lower extremity DVT was 18.7% (41/219) in 36 patients. PE incidence was 3.7% (8/219 patients), and the paradoxical embolus rate was 0.5% (1 patient). Prophylactic IVC filter use reduced the odds of developing a pulmonary embolus (OR = 3.7, P < 0.05) compared with population controls. Patients receiving Greenfield filters had significantly higher VTE incidence than those receiving retrievable filters (OR = 2.8, P = 0.008). Anesthesia duration of more than 8 hours significantly increases VTE incidence (P = 0.029). No statistical significance (P < 0.05) was noted with combined anterior-posterior approach (118 patients) versus posterior-only approach (101 patients) and the incidence of DVT (24/118, 20.3% for former; 17/101, 16.8% for latter). There were a total of 14 deaths; none related to PE or paradoxical embolism during an 8-year period. Mean and median follow-up was 2.8 and 2.4 years, respectively, with 126 achieving 2 or more years of follow-up. VTE-related morbidity and mortality have heightened the awareness within the spine community to the perioperative management of patients undergoing major spinal reconstruction. Prophylactic IVC filter placement significantly lowers VTE-related events, including PE development, than population controls.

Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma

Invited Commentary.

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.

A Comparison of Clinical Outcomes with Retrievable and Permanent Inferior Vena Cava Filters

Trends in inferior vena cava filter placement and retrieval at a tertiary care institution

Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach

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