Filter Tilt Research Articles

Experimental Study on Penetration of Smaller Inferior Vena Cava after Conical Filter Placement: Results in a Swine Model

Inferior vena cava (IVC) penetration is a prevalent complication following the placement of conical filters. However, there is a paucity of studies examining the penetration in smaller IVC. The objective of this study was to assess the time of penetration, the incidence of serious complications associated with penetration, and the process of IVC wall repair in the smaller IVC following the placement of a conical filter. Twenty pigs were randomly assigned to two groups and received either Celect or Denali filters. Weekly follow-up imaging using computed tomography venography (CTV) of the IVC was conducted to monitor the position of the IVC filter struts until at least one strut was observed to be penetrating the vessel wall. At necropsy, a comprehensive gross and histological examination was performed on the IVC and adjacent anatomical structures in all animals. The puncture and cavography procedures were successfully conducted on all animals, and no significant differences were found in the mean diameter of the IVC between the Celect and Denali groups ( 15.89 ± 1.27 mm vs. 16.39 ± 1.39 mm, P ＜ 0.001). All filters were implanted without complications. CTV detected IVC penetration within nine weeks, confirmed during necropsy. The Celect group had a significantly earlier time of IVC penetration compared to the Denali group ( 2.43 ± 0.52 weeks vs. 6.81 ± 1.32 weeks, P ＜ 0.001). No evidence of filter tilt, fracture, migration, caval thromboses, retroperitoneal bleeding, wall hematoma, tearing of the IVC wall, or peripheral tissue and organ damage was observed during the CTV and subsequent necropsy. Additionally, histological analysis showed that the Celect group had a lower percentage area of collagen fiber compared to the Denali group (33.92% vs. 49.04%, P ＜ 0.001). The fiber proliferation was positively correlated linearly with the indwelling time of filter (r = 0.97, P ＜ 0.001) . Penetration can occur within a relatively brief period following the placement of the conical filter into the smaller IVC. Nevertheless, no short-term severe complications were observed in connection with the penetration. The proliferation of fibers in the IVC wall exhibited a positive linear correlation with the duration of filter indwelling.

The Inferior Vena Cava Filter Placement Parameters May Predict Filter Retrieval Outcomes

ObjectiveWe aimed to investigate the potential correlation between the placement factors of various retrievable inferior vena cava filters and retrieval outcomes. Additionally, we aimed to identify the factors affecting the placement tilt of the filter. Materials and methodsThis retrospective study was conducted at a tertiary care center to investigate patients who had previously undergone retrievable filter placement at our center and who subsequently had their filters removed between January 2020 and December 2021. Patient characteristics and filter-related factors were recorded. Complex filter retrieval was defined as cases that required a minimum of 8 minutes of fluoroscopy or that involved advanced techniques. Regression models were used to explore patient- and placement procedure-related factors that could influence retrieval outcomes and the placement tilt angle. ResultsThe study included 163 patients, and all filters were successfully retrieved. Thirty-seven (22.7%) retrievals were classified as complex retrievals. The mean diameter of the inferior vena cava in the preplacement position for the entire cohort was 16 ± 1.8 mm. The median filter tilt angles at placement and retrieval were 5.0° (IQR, 1.8°- 9°) and 4.6° (IQR, 2.1°-8.0°), respectively. The placement tilt angle was not significantly associated with complex retrieval (p=0.59). The filter hook abutment to the vena cava wall (OR, 10.76, p = 0.003), dwell time (OR, 1.02, p =0.029), and diameter of the vena cava (OR, 10.21, p < 0.001) were associated with complex retrieval. The diameter (p=0.049), age (p=0.049), and filter brand (p=0.001) were found to be significantly associated with placement tilt. ConclusionsThe inferior vena cava diameter at the time of placement predicts difficulty in filter retrieval. In addition, the filter hook abutting the IVC wall and long indwelling time may complicate retrieval. The vena cava diameter is also closely related to the degree of filter tilt.

Retained Inferior Vena Cava Filter Retrieval: Novel Approach Using Tiger Tooth Foreign Body Holding Forceps

Abstract Only about one-third of all inferior vena cava (IVC) filters are successfully retrieved. This is largely due to factors such as IVC occlusion, filter tilt, and caval wall penetration among other reasons. IVC filter retrieval methods currently followed in practice involve the use of standard snares and wires, endobronchial forceps, LASER-tipped sheaths, and even open surgery. However, the success rate of filter retrieval continues to remain low, thereby increasing the risk of complications associated with retained IVC filters. This warrants a need to explore and adopt newer techniques of IVC filter retrieval. In this case report, we describe the novel use of a tiger tooth foreign body holding forceps in the successful retrieval of a retained IVC filter in an elderly man with intracranial hemorrhage.

Predictors of endobronchial forceps utilization for inferior vena cava filter retrieval: when snare retrieval fails

BackgroundEndobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps.MethodsRetrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail.ResultsThirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74–11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2–157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05).ConclusionIVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps.Level of evidenceLevel 3, large multicenter retrospective cohort.

Relationship between vascular access and angulation of vena cava filter at placement and retrieval: a multicenter retrospective cohort study.

Inferior vena cava (IVC) filters are commonly used intravascular devices designed to prevent fatal pulmonary embolism (PE), maintaining the IVC filter as centered as possible is fundamental for achieving its filtration function. This study aimed to characterize the tilt angles of IVC filter between the vascular access of internal jugular vein (IJV) and femoral vein (FV), as well as to identify factors associated with increased or decreased tilt angles between placement and retrieval. This is a multicenter retrospective study. A multicenter retrospective study was conducted from October 2017 to March 2019. The primary outcome was the change in filter tilt between placement and retrieval. The secondary outcome was the identifications of factors associated with increased or decreased tilt angle. Relevant variables were analyzed using t-tests, Chi-square tests, Fisher's exact tests, while multivariate logistic regression analysis was used to determine risk factors. A total of 184 eligible patients were included in this study. The IJV group had a lower likelihood of tilt angle over 10° at the time of placement compared to the FVs group (0% versus 12.5%, p = 0.040). Among the 171 patients with a mean dwell time of 22.1 days, the IJV group had a higher likelihood of tilt angle over 10° than the FVs group (10.3% versus 2.3%, p = 0.080). The use of FVs access at placement was associated with a higher difference between placement and retrieval filter tilt angles (p < 0.01). Multivariate logistic regression analysis showed that hypertension [odds ratio (OR) 0.668; 95% confidence interval (CI) 0.328-1.358, p = 0.265], cardiologic artery disease (OR 0.537; 95% CI 0.136-2.130, p = 0.377), cerebral venous disease (OR 0.555; 95% CI 0.186-1.651, p = 0.290), filter types (OR 1.624; 95% CI 0.851-3.096, p = 0.141), and IVC filter thrombosis (OR 1.634; 95% CI 0.804-3.323, p = 0.175) were not associated with increased filter tilt angle. Right side (OR 0.434; 95% CI 0.202-0.930, p = 0.032) or bilateral lower extremity deep vein thrombosis (LEDVT) (OR 0.383; 95% CI 0.148-0.995, p = 0.049) were identified as protective factors. IJV access was associated with a lower filter tilt angle at the time of placement, while FVs access was linked to a higher difference between placement and retrieval tilt angles. Right side or bilateral LEDVT were identified as protective factors against increased IVC filter tilt angle.

Safety and efficacy of the VenaTech™ Retrievable inferior vena cava filter: a first-in-man single-center prospective study

BackgroundVenous thromboembolism (VTE) is a frequent condition worldwide, associated with significant morbidity and mortality. Though its primary treatment is anticoagulation, the placement of an inferior vena cava (IVC) filter is recommended in patients with some comorbidities. The objectives of this study were to evaluate the clinical safety and efficacy of the Venatech® retrievable IVC filter. This open-label prospective single-center study was conducted on 40 consecutive patients requiring temporary or permanent IVC filtration. Patient characteristics, technical success rates of filter placement and removal, and the occurrence of complications were assessed. Follow-up imaging was performed using CT-scan before retrieval or at 6 months in the permanent indication population.ResultsThe filter was successfully implanted at the intended location in all the patients. Retrieval was attempted in 21 (52.5%) patients after a mean period of 50 days (range: 6–94 days), and the filter was successfully removed in 18 patients (85.7%). Reason for retrieval failure was filter with trapped thrombus (n = 2) and a > 15° tilt (n = 1). No complication was observed during the filter placement and retrieval. Follow-up imaging available in 30 patients (75%) demonstrated deep filter penetration (> 3 mm) in four patients (13.3%), severe filter tilt (> 15o) in five patients (16.7%), filter with trapped thrombus in three patients (10%), but no fracture or IVC thrombosis.ConclusionThis prospective study showed encouraging preliminary results of the safety and efficacy of the Venatech® retrievable IVC filter. The filter was easily delivered in the intended position and successfully removed in a high percentage of patients.Trial registrationClinicalTrials.gov Identifier: NCT02674672

The Degree of Inferior Vena Cava Filter Tilt Associated With Challenging Retrieval

Inferior vena cava (IVC) filter tilt is associated with technical difficulties at the time of retrieval. However, the degree of tilt that predisposes patients to undergo complex or failed retrieval has not been defined.

Safety and efficacy of inferior vena cava filter retrieval: a 5-year single center retrospective review from a tertiary care center

BackgroundInferior vena cava (IVC) filter retrieval is typically accomplished with standard snare technique. When this fails, more advanced techniques are necessary, especially when removal falls outside a 12-month window. Complications during filter retrieval depend heavily on technique, type of filter, and filter position. In this study we examined safety and efficacy of 536 filter retrievals at a tertiary care center and compared complication rates between standard snare and endobronchial forcep retrieval.MethodWe reviewed 536 cases between August 2015 and August 2020, recording retrieval success rates, patient comorbidities, and complication rates at the time of removal.ResultsTotal overall retrieval success was 97.9% (525/536), and complications occurred in approximately 6.0% (32/536) of all cases. Success and complications with standard snare technique alone were 99.4% (345/347) and 1.7% (5 Grade I/II, 1 Grade III) and advanced forcep technique 98.8% (171/173) and 14.5% (22 Grade I/II, 2 Grade III, and 1 Grade IV), respectively. There was no significant difference between the technical success rates of the standard snare technique and forceps techniques (p = 0.60) despite a significantly longer dwell time in patients undergoing forceps retrieval (p < 0.001).ConclusionTo our knowledge, this is the largest cohort of forceps directed IVC filter retrieval present in the literature. Rates of successful endobronchial forceps and standard snare retrievals in this study are similar to previous reports. Although use of endobronchial forceps may be associated with higher complication rates, this is likely due to prolonged dwell times, filter tilt, and attempted removal of non retrievable filters. Overall, forceps-directed retrieval offers a safe, effective means of removal in difficult cases.Level of evidenceLevel 3, Large Retrospective Study.

Lateral tilt during IVC filter placement does not predict the need for advanced filter retrieval techniques.

We aimed to determine if lateral inferior vena cava (IVC) filter tilt at placement predicts the need for subsequent advanced retrieval techniques. A retrospective chart review was performed of all Gunther Tulip IVC filter placements with subsequent retrievals between February 2015 and October 2017. Chart and imaging review was performed for patient, filter placement, and filter retrieval demographics/characteristics. Degree of agreement between two measurement sets was evaluated with the intraclass correlation (ICC) analysis. Categorical variables were compared with chi-square or Fisher exact test, as appropriate. Kendall rank correlation was used to measure correlation between categorical variables. There was poor agreement between filter tilt angle at the time of placement and retrieval (ICC coefficient, 0.54). Mean difference ± standard deviation between tilt angle at the time of placement and retrieval was 4.6°±4.3° (p = 0.35). Among patient- or procedure-related factors, a common femoral vein access on placement (regression coefficient, -2.90; p = 0.039) was associated with a lower difference between placement and retrieval filter tilt angles compared to internal jugular vein access. Higher filter tilt angle measured at the time of retrieval (OR: 1.19, p = 0.025), hook embedment (OR: 77.3, p < 0.001), and a longer dwell time (OR: 1.25, p = 0.002) were associated with the need for advanced retrieval techniques. However, in univariate and multivariate analysis filter tilt angle at the time of placement was not associated with the subsequent need for advanced retrieval technique (p = 0.16). Lateral tilt at the time of placement is poorly associated with lateral tilt at the time of retrieval and does not correlate with the need for advanced retrieval technique.

Retrievable Inferior Vena Cava Filters-Use, Removal, and Removal Techniques.

The use of retrievable inferior vena cava filters is on the rise, but there is an inadequate number of these filters being removed even if their use as a prophylactic for venous thromboembolism is no longer indicated. Complications with retrievable filters that remain in the patient for an extended duration include examples such as filter tilt and embedding into the caval wall. This raises concerns for whether the filter is properly functioning and for consequent sequelae, including recurrent thrombosis, stenosis, or inferior vena cava perforation. With these complications, there are also challenges to retrieving these filters via the standard techniques and thus more advanced techniques are required. Both standard and advanced techniques, their uses, and possible risks of these methods are also discussed.

Digital radiograph (DR) guided bedside IVC filter placements in patients with intracranial pressure monitors

PurposeThe purpose of this study is to report a single center experience with portable digital radiographically (DR) guided bedside IVC filters placed in intensive care unit (ICU) patients with high ICP and elevated head of bed (HOB). Materials and methodsA retrospective chart review was conducted on all bedside IVC filters placed from January 1, 2010 to September 16, 2020. Patients with high ICP and elevated head of bed requirements were included. Charts were reviewed for filter type, common femoral vein (CFV) access, filter location, pre procedure imaging, pre and post filter ICPs, glascow coma scale, number of radiographs taken, and filter removal. ICPs were obtained 1 ​h prior to procedure and 2 ​h post procedure and analyzed with a paired T test.Filters were placed by reviewing prior CT scan for IVC size, caval variants, renal and iliac veins and vertebral body landmarks. Then, CFV access was obtained and a Bentson wire was advanced 30–40 ​cm. A radiograph was used to confirm adequate position of the of the wire. The filter sheath was advanced and serial radiographs were used to position the filter sheath at the final predetermined position below the renal veins and above the iliac bifurcation. The filter was deployed, and a radiograph was obtained to confirm filter positioning. ResultsA total of 9 DR guided bedside IVC filters were placed (4 Denali, 3 Option Elite, 2 Celect). Indications included prophylactic placement (n ​= ​8) and acute DVT (n ​= ​1). The average patient age was 35.8 years (range: 18–56 years) CT abdomen and pelvis was used to assess for the level of renal veins in all patients (n ​= ​9). No caval variants were encountered on pre-procedural planning. The average pre, intraprocedural, and post procedure intracranial pressure was 16 ​mmHg, 13 ​mmHg, and 16 ​mmHg, respectively. Confirmation of placement after final placement was available in 7 patients (4 DR, 2 CT and one fluoroscopic examination). Two non-procedural related deaths occurred.Technical success, defined as successful placement of IVC filter at the predetermined level, was achieved in 100% of patients (n ​= ​9). The right CFV was used in most patients (n ​= ​7). The left CFV was used for access in two patients due to right CFV thrombus (n ​= ​1) and existing right femoral venous central line (n ​= ​1). The average number of radiographs taken was 5.8 (range 4–9). In all cases, filters were placed below the level of the lowest renal vein (n ​= ​9). A comparison of pre, during and post intervention ICP pressures is shown in table, 2. No differences between pre and post filter ICP was noted (p ​= ​0.77). Three filters were later removed. One minor complication was reported, which was filter tilt (23%) in an Option filter. ConclusionBedside IVC filters can be safely placed in patients with head trauma and high ICP who are unable to lay supine using portable DR guidance with a high rate of technical success and minimal complications.

Inferior vena cava filter tilting between placement and retrieval is associated with caval diameter and need for complex retrieval techniques

PurposeInferior vena cava (IVC) filter tilt may lead to apex embedment and need for advanced retrieval techniques. This study assesses factors associated with filter tilt change over time and need for complex retrieval procedures. Materials and methods252 consecutive patients underwent retrievable IVC filter placement and removal at a single academic institution over 58 months. 182 (72.2%) patients met inclusion criteria. IVC filters included 168 (92.3%) Gunther Tulip and 14 (7.7%) Option filters. The primary outcome was medial-to-lateral IVC filter tilt change between placement and retrieval. Secondary outcomes included advanced retrieval technique use and multiple retrieval attempts. Independent variables included demographics, IVC diameter, filter hook position relative to the renal veins, and dwell time. Associations were determined using student's t-tests, ANOVA, and linear and logistic regressions. ResultsMean IVC diameter at placement was 19.2 ± 3.3 mm. Mean filter tilts at placement and retrieval were 6.1 ± 4.9° and 5.2 ± 5.0°, respectively. Mean tilt change was 5.0 ± 5.0°. Larger IVC diameter was associated with greater filter tilt change (p = 0.0004). While IVC diameter did not independently predict retrieval difficulty, greater tilt change and prolonged dwell time were associated with increased advanced retrieval technique use (p = 0.01 and 0.002, respectively). Results were unchanged in a subgroup analysis of patients treated with Gunther Tulip filters. ConclusionLarger IVC diameter predicts increased filter tilt change, which in turn is associated with challenging retrievals. Attention to IVC diameter during filter placement may anticipate tilt-related complications.

Comparison of Retrievability and Indwelling Complications of Celect and Denali Infrarenal Vena Cava Filters: A Randomized, Controlled Trial.

To compare the Celect and Denali filters in terms of complex filter retrieval and indwelling complications after a 2-month indwelling time. 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. Of 136 participants (mean age, 62 ± 12.8years, 55 male), 24 (17.6%) were lost to follow-up. The mean indwelling time of filter was 60.4 ± 7days 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. 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.

Comparative outcomes of Inferior Vena Cava filters placed at bedside using digital radiography versus conventional fluoroscopy

PurposeTo retrospectively assess the outcomes of Inferior Vena Cava (IVC) filters placed in critically ill patients in the ICU at bedside using digital radiograph (DR) guidance with previous cross-sectional imaging for planning, compared to IVC filters placed by conventional fluoroscopy (CF). Method and materialsThe cohort consisted of 129 IVC filter placements; 48 placed at bedside and 81 placed conventionally from July 2015 to September 2016. Patient demographics, indication, radiation exposures, access site, procedural duration, dwell time, and complications were identified by the EMR. IVC Filter positioning with measurements of tip to renal vein distance and lateral filter tilt were performed when cavograms or post placement CTs were available for review. Statistical analysis was performed using Stata IC 11.2. ResultsTechnical success of the procedure was 100% in both groups. Procedural duration was longer at the bedside lasting 14.5 +/- 10.2 versus 6.7 +/- 6.0 ​min (p<0.0001). The bedside DR group had a median radiation exposure of 25 ​mGy (15–35) and the CF group had mean radiation exposure of 256.94 ​mGy +/- 158.6. There was no significant difference in distance of IVC tip to renal vein (p=0.31), mispositioning (p=0.59), degree of filter tilt (p=0.33), or rate of complications (p=0.65) between the two groups. ConclusionIVCF placement at the bedside using DR is comparable to CF with no statistical difference in outcomes based on IVCF positioning, degree of lateral tilt or removal issues. It decreased radiation dose, but with overall increased procedural time.

Abstract No. 178 Larger inferior vena cava diameter is associated with greater filter tilt change and need for advanced retrieval techniques: an analysis in 189 consecutive patients

Inferior vena cava (IVC) filter tilt may lead to apex embedment and need for advanced retrieval techniques. The purpose of this study was to assess patient and procedural factors associated with filter tilt change, with the hypothesis that larger IVC diameter predisposes to increased filter tilt change and more difficult filter retrievals.

Abstract No. 543 Femoral, venous, or brachial venous access for Option vena cava filter placement: is there a difference in post-deployment filter tilt?

Abstract No. 543 Femoral, venous, or brachial venous access for Option vena cava filter placement: is there a difference in post-deployment filter tilt?

Abstract No. 671 The effect of inferior vena cava size on filter complications: one size does not fit all

To determine the effect of inferior vena cava (IVC) size on development of complications as determined on post placement CT scan, including filter tilt, penetration, and thrombosis. Patients that underwent IVC filter placement between March 2015-December 2017 were included in the study. Coronal and sagittal CT scan images before placement of the filter were used to measure the medio-lateral (ML) and antero-posterior (AP) diameters of the IVC, 2 cm below the right renal vein. Two- dimensional (2D) axial IVC size at this level was then calculated using the ML and AP diameters. CT scan images after placement of the filter were reviewed for any complications, including filter tilt, penetration and thrombosis. IVC filter ML diameter, AP diameter and 2D axial sizes were then compared between patients with and without complications in CT scan. A total of 86 patients (female = 59%, male = 41%, age: 67 ± 14.1 years) were enrolled. The CT scan before placement of filter was available at 2.2 ± 5.2 months. The complications noted in the post filter placement CT scan (interval = 5.4 ± 6.75 months) were tilt in 32(37%) patients, penetration in 4(4.7%) and thrombosis in 8(9.3%) patients. Patients with tilt had significantly larger 2D axial IVC size compared to patients without tilt. Almost significant association was also noted in terms of ML diameter; however, no significant difference was noted in terms of AP diameter. There is significant association between the two-dimensional (2D) size of the IVC and future complications such as tilt noted on post placement CT scan. Two-dimensional evaluations of the IVC could provide clinicians better insight regarding the anatomy of the IVC, particularly considering the variability of the IVC size with hydration status and respiration. Future large sample studies should further define the filter specific thresholds.Tabled 1IVC AP diameter (mm)IVC ML diameter (mm)No tilt (n=54)15.9 ± 4.819.3 ± 2.9992.7 ± 400.7Tilt (n=32)17.7 ± 4.820.8 ± 3.61184.7 ± 452.8P value0.110.050.04 Open table in a new tab

Over-the-wire deployment techniques of option elite inferior vena cava filter: 3D printing vena cava phantom study

PurposeTo compare filter tilt and filter jumping during Option inferior vena cava (IVC) filter deployment with 3 different wires techniques using a 3-dimensional (3D) printing vena cava phantom. Materials and methodsAn IVC 3D printed vena cava phantom was made from a healthy young male’s computed tomographic data. Option IVC filters were deployed with 3 different wires: i) original push wire, ii) hydrophilic stiff wire, and iii) bent stiff wire. Right internal jugular and right femoral access were used 5 times with each wire. Filter tilt angle, tilt ratio, jumping, and tip abutment to the IVC wall were analyzed. ResultsThe transfemoral approach with original push wire had significantly higher tilt angle than did the transjugular approach (6.1˚ ± 1.9 vs. 3.5˚ ± 1.3, p = 0.04). Mean tilt ratio was significantly lower with the bent wire with transfemoral access (0.49 ± 0.13 vs. 0.78 ± 0.18 [original push-wire] and 0.67 ± 0.08 [stiff wire], p = 0.019). The ratio was lower also with original push wire with transjugular access (0.34 ± 0.19 vs. 0.57 ±0.11 [stiff wire] and 0.58 ±0.17 [bent wire], p = 0.045). Filter jumping occurred more often with the transjugular approach with original push wire than with stiff or bent-wire delivery. Filter tip abutment to the IVC wall occurred only with the transfemoral approach. ConclusionsBent wire with transfemoral access and original push wire with transjugular access had lower filter tilt ratio at Option IVC filter deployment. However, filter jumping was common using the original push wire with transjugular access.

Suprarenal Inferior Vena Cava Filter Placement and Retrieval: Safety Analysis.

To evaluate safety and retrieval success of retrievable suprarenal inferior vena cava (IVC) filters. A retrospective chart review of patients who received a retrievable suprarenal IVC filter between January 2008 and December 2017 was conducted. Suprarenal IVC filters were placed in 24 female and 27 male patients. The most common indications for filter placement were IVC thrombus (n= 20; 39.2%) and iliofemoral venous thrombosis with contraindication to anticoagulation (n= 16; 31.3%). The most common indications for suprarenal placement were IVC thrombus (n= 20; 39.2%), anatomic variants (n= 17; 33.3%), and external IVC compression (n= 8; 15.8%). Duplicated IVC was the most common anatomic variant requiring suprarenal placement (n= 7; 13.7%). Günther Tulip (n= 40; 78.4%), Denali (n= 10; 19.6%), and Celect (n= 1; 2.0%) filters were used. Retrieval was attempted in 27 of the 51 filters placed (52.9%). Of the 27 attempted retrievals, the technical success rate was 100% (27/27). The median dwell time was 87.0 days (95% confidence interval, 28-137 d). One complication involving fractured struts during filter retrieval occurred. No significant change in craniocaudal filter position, lateral filter tilt, or renal function between placement and retrieval was observed (P < .05). There were no instances of indwelling filter fracture. Suprarenal IVC filters, when indicated, can be placed and retrieved with a low complication rate.

A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

Abstract Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.