Inferior Vena Cava Penetration Research Articles

Denali Inferior Vena Cava Filter Retrieval: Complications and Success Rates.

The present study was to evaluate the outcomes of Denali filter retrieval. We retrospectively reviewed 143 patients who received Denali filter insertion from September 2015 to April 2020. Ninety-seven patients who required removal of the filters were include in this study. Filters were retrieved with either standard or advanced techniques. Venography before and after retrieval was obtained to evaluate technical success, complications and duration of filter insertion. All 97 filters were retrieved successfully without complications. Ninety-two (94.8%) were retrieved with standard technique and 5 filters (5.2%) required the advanced technique. There were two cases with a filter angle greater than 15 degrees. Inferior vena cava penetration was shown in 17 patients (17.5%) on venography but was not associated with contrast media extravasation after filter removal. The Denali filter showed a high rate of successful retrieval without complications. This study adds value to previous studies and trials showing that the Denali filter is a reliable and safe filter that can potentially improve retrieval rates, with increasing use of this device.

Inferior Vena Cava Filter Litigation Review: An Analysis of Medicolegal Cases Pertaining to Inferior Vena Cava Filters

PurposeTo identify and analyze all medical malpractice and product liability lawsuits pertaining to inferior vena cava (IVC) filters published within a well-recognized legal research database. Materials and MethodsLexisNexis, a legal research database, was used to retrieve cases that mentioned harm from IVC filters, or lack thereof, as the cause for legal action. A total of 672 cases were analyzed for type of case (medical malpractice or product liability), filter model implanted, filter complications, court decisions, and settlement payments if any. ResultsOf 95 analyzed cases, 20 (21.1%) were medical malpractice cases and 75 (78.9%) were product liability cases. C.R. Bard was the manufacturer associated with the most lawsuits (n = 41, 48.8%). The most litigious filters were the G2 filter from C.R. Bard (n = 17, 20.2%) and Greenfield filter from Boston Scientific (n = 17). The most common complications were IVC penetration (n = 26, 29.9%), filter migration (n = 26, 29.9%), filter fracture (n = 23, 26.4%), and tilt (n = 16, 18.4%). The number of product liability cases has increased from accounting for 25.0% (2 of 8) of filter lawsuits between 2000 and 2010 to 83.9% (73 of 87) during 2011–2020. Of the 20 medical malpractice claims, 9 (45%) were filed for failure to place a filter. One physician was found liable for filter-related complications by a state court in 2014. ConclusionsThe majority of recent IVC filter–related lawsuits are filed against manufacturers on the basis of product liability claims, with the main litigious filters being the G2 and Greenfield filters. Most cases resulted in rulings for physicians or manufacturers. Some were filed against physicians for filter-related complications or for failure to place an IVC filter.

Influence of Exercise on Inferior Vena Cava Wall Interaction with Inferior Vena Cava Filters: Results of a Pilot In Vivo Porcine Study

Abstract Objectives The aim of this study was to assess the effect of mild exercise on inferior vena cava (IVC) filter interaction with imaging and pathological features with the neighboring vessel wall utilizing a porcine model. Materials and Methods After Institutional Animal Care and Use Committee (IACUC) approval, retrievable Option Elite IVC filters were implanted in six Yorkshire pigs utilizing the right common femoral vein approach under general anesthesia. Group A (n = 4) pigs remained sedentary for 4 weeks. Group B (n = 2) pigs were exercised using a harness and treadmill for 10 minutes/day for 4 days/week. At approximately 4 weeks, IVC venograms were performed and the pigs were sacrificed. After laparotomy, the IVC was ligated above and below the filter, excised and fixed in formalin. Gross and histological examination of the IVC was performed. Gross images of each sample were captured before removal of the filters. One longitudinal, one tangential, and five transverse representative sections were processed for paraffin sectioning and hematoxylin and eosin slides were prepared. A pathologist examined all tissues to assess differences between normal vein, group A and group B pigs. The pathologist provided an overall assessment and representative images. Results All IVC filter implantations were technically successful without adverse effects. There was no incidence of caval thrombosis, filter strut fracture, or filter migration in either group. On gross pathological examination, IVC of the pigs in group B demonstrated more perivascular and mural fibrosis than those pigs in group A. Histopathological findings correlated with gross findings. Conclusions In this pilot study, there were no incidence of IVC filter strut fracture, penetration or IVC occlusion in sedentary or exercised pigs. However, there tended to be more perivascular and mural fibrosis on pathological examination of inferior vena cavas from exercised pigs. Further larger scale studies may employ the porcine model to further understand the role exercise may play on IVC filter and caval wall interaction.

Inferior Vena Cava Filter Utilization at Kingston Health Sciences Centre: A Comparison of Practice with Guidelines

Background: Inferior vena cava (IVC) filters offer mechanical protection against pulmonary embolism in high risk patients. Guidelines have recommended their use be limited. “Don't use inferior IVC filters routinely in patients with acute venous thromboembolism” (ASH Choosing Wisely, 2013). “For patients with acute VTE who are treated with anticoagulation, the guideline recommends against the use of an inferior vena cava filter.” (CHEST Antithrombotic Therapy and Prevention of Thrombosis, 2016) IVC filters implanted for longer than 100 days confer a significantly higher risk of complications (Odds Ratio 2.3, Dinglasan et al. 2013). We sought to determine compliance with these recommendations at Kingston Health Sciences Center (KHSC), an academic tertiary referral center with 440 inpatient beds at Queen's University in Kingston, Ontario, Canada.Methods: Approval was obtained from the Queen's Health Services Research Ethics Board.Consecutive patients with IVC filter implantation at KHSC from August 1st, 2013 to August 1st, 2016 were identified through Interventional Radiology records. All charts were retrospectively reviewed in depth by one investigator followed by review and discussion. Data extracted included: patient demographics and disposition, details surrounding IVC filter insertion and removal, and IVC filter related complications. The indication for filter implantation was classified as clearly consistent or not clearly consistent with CHEST guidelines. The category ‘lesser indication’ was subsequently added for cases of a more subjective nature where definitive categorization was challenging.Results: Between August 2013 and August 2016, 95 IVC filters were implanted at KHSC. Among these, 42 (44.2%) patients were male and the median age was 67 (ages ranged from 17 to 91). The most responsible services ordering IVC filter implantation were Critical Care Medicine (37.9%), Internal Medicine (32.6%), Surgery (12.6%) and other services such as Neurology, Family Medicine and Emergency Medicine (16.9%).Complications arose in 21 patients (22.1%) including filter-associated thrombosis (11), filter migration or tilt (8), IVC penetration (5), IVC perforation (2), and one instance of suspected IVC filter seeding with methicillin sensitive Staphylococcus aureus (MSSA) leading to bacteremia. The mean dwell time of filters that were successfully removed (n=52, 54.7%) was 69.2 days, with thirteen (18.1%) remaining indwelling beyond 100 days. Of those in whom the filter was not removed (n=43), unsuccessful retrieval attempts were made in eight, 23 patients died with their filters in situ within 100 days of implantation, and in 12 patients no record of an attempt to retrieve the device was found.Indication for IVC filter insertion was clearly consistent with CHEST guidelines in 58 (61.1%) patients. Insertion alongside therapeutic anticoagulation/thrombolysis or for prophylaxis in patients without VTE occurred in 26 patients (27.4%) and was considered not consistent with current recommendations. In 8 (8.4%) patients, a ‘lesser indication’ was identified. Lesser indications included cases where there was a need to withhold anticoagulation for less than 24 hours for procedures or surgeries, such as endoscopic retrograde cholangiopancreatography (ERCPs) or ankle open reduction internal fixations (ORIFs). Three charts had insufficient information to determine compliance.Discussion: The main limitation of this study is its retrospective nature with reliance on chart documentation. In addition, it is recognized that guidelines surrounding IVC filter use do not apply to all possible clinical scenarios. Nonetheless, restricting the use of IVC filters to appropriate indications is an important endeavour. These devices are costly, can cause harm, and do not have a strong evidentiary basis. Educational initiatives are underway to optimize use of IVC filters at KHSC. Additional interventions under consideration include development of a specific requisition form listing recommended indications, and creation of an IVC filter insertion database as a prompt for timely removal. DisclosuresHay:Celgene: Research Funding; Roche: Research Funding; Abbvie: Research Funding; Kite: Research Funding; Amgen: Research Funding; Janssen: Research Funding; Novartis: Research Funding.

Retrieval of Bard Simon Nitinol inferior vena cava filters: Approaches, technical successes, complications, and clinical outcomes.

The Simon Nitinol filter is a bi-level filtration device designed for permanent implantation that is no longer commercially available, but may result in similar complications to current commercially available long term indwelling temporary or permanent filters. Complications related to indwelling inferior vena cava filters include inferior vena cava thrombosis, inferior vena cava penetration, filter migration, and filter fracture. There is a paucity of reports describing the technical aspects related to retrieval of Simon Nitinol filters. This study consisted of five patients with Simon Nitinol filters and describes the indication for retrieval, the retrieval techniques used to remove the filters, technical success, complications, and clinical course. The indications for retrieval included: abdominal pain (n = 2; 40%), iliocaval thrombosis (n = 1; 20%), identification of an intracardiac filter fragment (n = 1; 20%), and recurrent venous thromboembolic events (n = 1; 20%). Retrieval techniques included: biopsy forceps (n = 3; 60%), excimer laser extraction sheaths (n = 3; 60%), hangman modified loop snares (n = 3; 60%), rigid endobronchial forceps (n = 2; 40%), and balloon deflection (n = 2; 40%). All filters were successfully retrieved. One patient developed a post-procedural intramuscular hematoma near the site of right internal jugular sheath placement. Simon Nitinol filters may be retrieved safely and effectively using advanced inferior vena cava filter retrieval techniques.

Contemporary management of chronic indwelling inferior vena cava filters

ObjectiveDespite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended timeline. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate the contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center. MethodsA retrospective analysis was performed from August 2015 through August 2019 of all patients who were referred for removal of a prolonged IVC filter with a dwell time >1 year. Descriptive analysis was used to evaluate patients' characteristics and procedural outcomes, which were reviewed through electronic medical records. Data were expressed as median with interquartile range (IQR) or number and percentage, as appropriate. ResultsA total of 47 patients were identified with a median filter dwell time of 10.0 years (IQR, 6-13 years); 34 patients underwent IVC filter removal, and 13 patients refused retrieval. The median age of patients was 54.9 years (IQR, 42.5-64.0 years); the majority were female (57%) and white (53%). The most common indication for filter placement was high risk despite anticoagulation (49%), followed by venous thromboembolism prophylaxis (21%). The majority of patients were symptomatic (72%). If symptomatic, the most common reason for retrieval was IVC penetration (94%), and the chief complaint was pain (56%). Retrieval success was 97%, with a median length of stay of 0 days. The majority of retrievals were performed through an endovascular approach (97%). There was one postprocedural complication (3%). ConclusionsDespite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.

Inferior Vena Cava Filter Retrieval Trends: A Single Center Experience

Background: Inferior vena cava (IVC) filters are indicated in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) who either have contraindications to or have failed anticoagulation (AC). Given rising concerns about their safety and efficacy, the FDA has issued a communication urging clinicians to remove filters (optimally, within 90 days post-implantation). According to national data retrieval rates remain low. Our study aimed to assess IVC filter retrieval rates and factors that influence retrieval. Methods: This is a single center, retrospective cohort study of patients who had IVC filter placement between December 2015 and December 2018. Subjects were identified using procedural codes for IVC filter insertion; data regarding demographics, comorbidities, retrieval, IVC filter-related complications and subsequent thromboembolic events were obtained by direct chart review. Survival analyses and a Cox regression model were performed using JMP statistical software. Results: Over 3 years, 494 patients with IVC filters were identified; 305 (62%) were retrievable. The average age at placement was 69±16 years; 249 (50%) were men and 332 (67%) were Caucasian. After excluding patients who died or were lost to follow-up within 30 days of placement or were discharged to hospice from the index admission, 258 patients with retrievable filters remained (54 retrieved). Indications for IVC filter placement were PE ± DVT 90 (35%), proximal DVT 159 (62%) and prophylactic 9 (3%). Forty two percent of patients (109) were restarted on AC at discharge, while an additional 18% (total 155) received AC at some point thereafter. The rate of retrieval was 8% at 90 days, 23% at 1 year and 28% at 2 years (Figure A). The proportional hazards model identified resumption of AC at any time (HR 3.11, 95%CI 1.6-6.8, p=0.0006) as the strongest predictor of retrieval; AC at discharge was not predictive. Advanced age at placement (HR 0.97 per unit change, 0.96-0.99, p=0.004) and active malignancy (HR 0.5, 95%CI 0.24-0.98, p=0.04) were associated with a lower likelihood of retrieval. The initial thrombotic event, the reversibility of the contraindication to AC, the placing service, sex, ethnicity and other comorbid conditions did not have an impact on retrieval. Kaplan-Meier analysis revealed that subjects who ever resumed AC had significantly higher rates of retrieval at 90 days (11% vs 3.4%) and at 1 year (33% vs 9.7%, log-rank p=0.0003, Figure B) when compared to those who did not. Only four patients experienced IVC filter-related complications (2 filter thrombosis, 1 IVC penetration, 1 device tilting); all occurred 2 or more years after placement. Recurrent thromboembolic events occurred in 50 patients (5 PE, 48 proximal DVT) with no significant difference in frequency between subjects with retrieved and non-retrieved filters; one PE and one DVT occurred at 1 month and 1 week respectively after retrieval. Conclusion: Despite efforts to increase awareness of IVC filter-associated complications, the unweighted retrieval rate remained below the nationally reported average of 30%. Persistent risk factors for thrombosis such as active malignancy or increasing age and poor prognosis may play a role in the decision to defer retrieval. In our study, resumption of AC proved a powerful predictor of retrieval, with rates approaching expected values in this population. Active surveillance for resolution of contraindications to AC post-IVC filter placement is crucial in increasing retrieval rates. Figure Disclosures No relevant conflicts of interest to declare.

2029 Perforated IVC Filter Leading to Duodenocaval Fistula and Massive Gastrointestinal Bleeding

INTRODUCTION: Inferior Vena Cava (IVC) filters are primarily indicated for patients with a history of deep venous thrombosis (DVT) or pulmonary embolism (PE) who have contraindications to anticoagulation. In most patients, the indication for placement of a filter is temporary. Although filter penetration of the IVC wall has been reported to range from 9% to 24% for all IVC filters, symptomatic perforation is rare and is reported to occur in about 0.4%-0.8% of cases. We are presenting a rare case of duodenocaval fistula presenting as massive gastrointestinal bleeding. CASE DESCRIPTION/METHODS: A 39-year-old male with a history of motor vehicle accident 10 years ago resulting in paraplegia and multiple lower extremity DVTs which required the placement of an IVC filter at that time was admitted to the hospital with one day of nausea, vomiting and hematochezia. History was very concerning for high volume bright red bleeding per rectum with associated non-bilious vomiting and dizziness. On arrival, he was hypotensive with a blood pressure of 60/40 mmHg, physical examination significant for actively oozing bright red blood per rectum. Labwork was remarkable for a Hemoglobin of 7.0 mg/dL and a BUN of 35 mg/dL. A CT scan of abdomen/pelvis with contrast revealed an IVC filter strut travelling through the IVC wall and perforating to the adjacent small bowel with active extravasation of the IV contrast to the small bowel, suggestive of a fistulous communication between IVC and a perforated loop of bowel. The patient was emergently taken to the operating room for exploratory laparotomy. IVC filter strut was found to be eroding through the IVC and into the duodenum confirming the CT findings. Transverse venotomy was performed and the filter was removed. An area of small bowel serosal tear was incorporated into the enterectomy segment, and end to end small bowel anastomosis was performed. IVC was repaired, and hemostasis was secured. Post-operatively, patient stayed stable clinically and hemodynamically with cessation of hematochezia. DISCUSSION: Duodenocaval fistula is a very rare complication of IVC filter placement, with around 10 reported cases in the literature. Even though it is rare, our case highlights the importance of a thorough and timely sensitive workup for an unstable patient with gastrointestinal bleeding and history of an IVC filter placement to rule out IVC penetration into surrounding viscera, since this can lead to significant morbidity and mortality if not recognized early during the clinical course.

2562 Duodenal Perforation From an Inferior Vena Cava Filter as a Rare Cause of Persistent Abdominal Pain

INTRODUCTION: Deep vein thrombosis (DVT) continues to be a significant source of morbidity for surgical patients. Inferior vena cava (IVC) filter placement is indicated for DVT in patients who have contraindications to anticoagulation or failure of anticoagulation. Over the last decade, there is exponential increase of IVC filter placement with increased complications reported. These include IVC penetration, IVC occlusion, insertion complication and filter migration. We report a rare case of symptomatic duodenal perforation by an IVC filter migration. CASE DESCRIPTION/METHODS: A 33-year-old female with a history of paraplegia secondary to motor vehicle accident, recurrent DVTs, and placement of IVC filter 10 years ago presented to the hospital for persistent epigastric pain for the past 5 years. Patient denied any nausea, vomiting, diarrhea, or hematochezia. Physical exam showed epigastric tenderness. Labs including complete blood count were unremarkable. CT scan showed a longstanding IVC occlusion with collaterals and displaced IVC filter into the duodenum and into the L3 vertebral body (Figure 1). An EGD confirmed prong migration to the second portion of the duodenum (Figure 2). This was distal to the ampulla and penetrating the duodenal wall with the tip embedding the opposite wall. Due to multiple workups being otherwise negative and symptomatic duodenal perforation of the IVC filter, she has been scheduled for an open IVC filter extraction with duodenal and caval repair. DISCUSSION: Duodenal and aortic perforations by IVC filters have been increasingly reported in the past 10 years although still rare. Penetration of the filter struts through the wall of the IVC can be asymptomatic. However symptomatic patients may present with epigastric pain, gastrointestinal bleeding and small bowel obstruction. Currently, there are no guidelines for the management of such patients. Most cases have been repaired using an open repair with excellent outcomes; however, endovascular retrieval and repair is being recognized as an alternative option especially in high risk patients. This case illustrates that even though IVC migration and perforation is a rare complication, it needs to be recognized as a potential cause for gastrointestinal symptoms in these patients. Retrievable IVC filters should always be removed if possible when deemed unnecessary to prevent complications such as migration from developing.

Hydronephrosis caused by inferior vena cava penetration by a mobin-uddin filter

The inferior vena cava (IVC) filter placement represents an excellent protection from significant pulmonary embolism in at-risk patients. Perforation of the wall of the IVC by components of caval filters is a recognized complication. We report a case of asymptomatic hydronephrosis caused by transcaval penetration of a Mobin-Uddin filter.

Should We Remove the Retrievable Cook Celect Inferior Vena Cava Filter? Eight Years of Experience at a Single Center.

BackgroundThe inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications.MethodsA retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated.ResultsThe most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004).ConclusionIf the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.

Caval Penetration by Inferior Vena Cava Filters: A Systematic Literature Review of Clinical Significance and Management

Inferior vena cava penetration is a frequent but clinically under recognized complication of inferior vena cava (IVC) filter placement. Symptoms occur in only about 1 out of 10 of all cases of caval penetration.

The quality of online patient-orientated information relevant to general and vascular surgery: A systematic review of cross-sectional studies

s / International Journal of Surgery 23 (2015) S15eS134 S72 0379: THE QUALITY OF ONLINE PATIENT-ORIENTATED INFORMATION RELEVANT TO GENERAL AND VASCULAR SURGERY: A SYSTEMATIC REVIEW OF CROSS-SECTIONAL STUDIES M. Sdobnikovs, L. Brown, A. Sureshkumar, A. Jawed, K. Patel, S. Shantikumar. University of Warwick, UK Aim: Many studies have assessed the quality of online information relating to general and vascular surgery, but there has been no systematic evaluation of this evidence. We performed a systematic review of studies evaluating the quality of patient-orientated online information relevant to general and vascular surgery. Methods: We systematically searched PubMed and EMBASE, up to December 2014, for studies that browsed the web for information on gastrointestinal or vascular surgical conditions and evaluated at least one aspect of the quality of retrieved websites. Search results were screened independently by two authors, with good interobserver reliability (k 1⁄4 0.84). Results: Of 1731 citations screened, 20 were included. These evaluated 1771 webpages relevant to general or vascular surgery. The most frequently assessed aspects were accuracy of information (n 1⁄4 15, 75%), readability (n 1⁄4 6, 30%) and completeness of information (n 1⁄4 5, 25%). Although there was large heterogeneity in the criteria used to assess website quality, 16 studies (80%) suggested that the overall quality of information on the web was inadequate. Conclusion: Systematic evaluation across a range of surgical conditions found a high prevalence of inaccurate, incomplete information online. Surgeons should be aware that patients may be reading misleading information, and consider signposting them to more appropriate reading material. 0382: A LOCAL AUDIT ON THE CONTENT AND QUALITY OF OPERATION NOTES USING THE ROYAL COLLEGE OF SURGEONS' GUIDELINES T. Constandinou, L. Ogunsanya, M. Joshi, C. Hathaway, H. Davies. Brighton and Sussex University Hospital, UK Aim: The Royal College of Surgeons (RCS) has produced clear guidelines for the required content of operation notes. The quality of surgical operation notes in a busy trauma centre was audited against these standards. Methods: A local retrospective audit was carried out over a six-week period. A proforma based on the RCS guidelines was used for data collection. Fifty sets of general surgical operation notes were randomly selected. To minimise bias, data that involved doctors participating in the audit were excluded. Results: None of the operation notes sampled fully complied with the RCS guidelines. The date of the operation was the best documented (98% compliance). Time of operation and CEPOD category were poorly documented (22% and 33% respectively), whilst only 68% of the notes were deemed legible. Conclusion: The quality of the operation notes sampled was well below the standard set by the RCS. Many trainees were not aware of existing guidelines. The RCS guidelines and these findings have been presented to the surgical department. Standardised proformas have been designed and a re-audit is currently in progress. We recommend that our surgical colleagues consider carrying out a similar audit where appropriate. 0464: THE RETRIEVABLE INFERIOR VENA CAVA FILTER: A SINGLE CENTRE STUDY S. Seewoonarain. Princess Alexandra Hospital, UK Aim: Retrievable inferior vena cava (IVC) filters offer an increasingly popular method of anti-coagulation in a subset of patients with contraindications to pharmacological anti-coagulants as recommended by the National Institute for Health and Care Excellence (NICE). It is advised that the temporary filter should be removed in order to avoid complications including occlusion, deep vein thrombosis, IVC penetration and filter migration. Manufacturing guidelines vary but most modern retrievable filters suggest removal at up to six months. The aim of this study was to assess the proportion of patients that undergo attempted retrieval of temporary IVC filters as planned at the time of insertion and the likelihood of retrieval. Methods: This was a retrospective, single-centre study conducted over seven years, investigating the efficacy and success rate of removing the retrievable filter. Results: During a seven year period, a total of 40 patients (18 male, 22 female) underwent successful placement of retrievable filters. 23 patients (57.5%) had retrieval planned at the time of insertion. 5 patients (21.2%) had successful retrieval as planned. Conclusion: Despite the increased use of the retrievable filter, the opportunity for retrieval is low. The question remains as to how best follow up patients to ensure timely removal of temporary filters. 0474: PATIENTS' AND SURGEONS' OPINIONS OF WHAT IS IMPORTANT ABOUT PATIENT EXPERIENCE IN OUTPATIENT CLINICS A. Seager, M. Bukhari. University Hospitals of Morecambe Bay NHS Trust,

Comparison of Complication Rates Associated with Permanent and Retrievable Inferior Vena Cava Filters: A Review of the MAUDE Database

PurposeTo compare the safety of permanent and retrievable inferior vena cava (IVC) filters by reviewing the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. Materials and MethodsThe MAUDE database was reviewed from January 1, 2009, to December 31, 2012. Product class search criteria were “filter, intravascular, cardiovascular.” Type of device used and specific adverse events (AEs) were recorded. ResultsFor the period January 2009–December 2012, 1,606 reported AEs involving 1,057 IVC filters were identified in the MAUDE database . Of reported AEs, 1,394 (86.8%) involved retrievable inferior vena cava filters (rIVCFs), and 212 (13.2%) involved permanent inferior vena cava filters (pIVCFs) (P < .0001). Reported AEs included fracture, migration, limb embolization, tilt, IVC penetration, venous thromboembolism and pulmonary embolism, IVC thrombus, and malfunctions during placement. Each specific AE was reported with significantly higher frequency in rIVCFs compared with pIVCFs. The most common reported complication with rIVCFs was fracture, whereas the most commonly reported complications with pIVCFs were placement malfunctions. For rIVCFs, the most commonly reported AE varied depending on filter brand. ConclusionsThe MAUDE database reveals that complications occur with significantly higher frequency with rIVCFs compared with pIVCFs. This finding suggests that the self-reported complication rate with rIVCFs is significantly higher than the self-reported complication rate with pIVCFs.

Clinical course and predictive factors for complication of inferior vena cava filters

The use of inferior vena cava (IVC) filters is associated with various complications. We aimed to elucidate the clinical course and predictive factors for complications of IVC filters, especially IVC penetration A retrospective observational study was performed in 45 adult patients with retrievable IVC filters and follow-up computed tomography (CT) between January 2003 and December 2012. Primary outcomes were the prevalence and predictive factors of IVC penetration. Secondary outcome was other complications of IVC filters. IVC penetration following filter placement occurred in 87.6% of patients, and 57.8% of those involved significant penetration. Embedding of filter tips, suggestive of lateral tilting, was observed in 51.1%. Both Vertebral body erosions and aortic penetrations were seen in 4.4%, but they were asymptomatic. Longer indwelling duration of the IVC filter was significantly associated with a higher grade of IVC penetration, and the risk of significant IVC penetration increased in patients with the filter indwelling time of more than 20 days and an IVC diameter of less than 24.2mm. In patients with a retrievable IVC filter, IVC penetration on CT was common, and significant IVC penetration was associated with a longer indwelling time of the IVC filter and a lesser IVC diameter.

Successful nonsurgical management of inferior vena cava penetration as a rare complication of percutaneous nephrostomy

Inferior vena cava penetration is a rare and life-threatening complication of percutaneous nephrostomy. This report describes our experience of successful nonsurgical management and smooth admission course. No similar case has been reported to our knowledge.

Endovascular Treatment of Late Aortic Perforation due to Vena Cava Filter

Perforation of inferior vena cava (IVC) by filter struts ranges from 9% to 24%, and clinical sequelae and complications are unpredictable. The aim of this article was to report an unusual case of late complication of IVC filter that caused an IVC wall perforation and penetration of the filter's hooks in the aorta, which was treated by endovascular procedure. Molding strut tip by balloon angioplasty, its accommodation with a bare stent, and its coverage and protection with an endoprosthesis is probably the first technique reported so far in this situation.

Open surgical inferior vena cava filter retrieval for caval perforation and a novel technique for minimal cavotomy filter extraction

Late complications of retrievable inferior vena cava (IVC) filters resulting from IVC perforation and erosion into adjacent structures is an increasingly frequent phenomena. We describe six cases of open filter explantation for IVC penetration and offer a novel technique for open filter removal without the need for an extensive cavotomy. All patients had radiographic evidence of filter erosion into pericaval structures requiring open surgical filter explant. Four of the six patients underwent minimal cavatomy filter extraction, eliminating the need for caval reconstruction.

Use of a Retrievable Vena Cava Filter with Low-intensity Anticoagulation for Prevention of Pulmonary Embolism in Patients with Cancer: An Observational Study in 106 Cases

Purpose To evaluate a retrievable inferior vena cava (IVC) filter in combination with low-intensity oral anticoagulation for prevention of pulmonary embolism (PE) in patients with malignancy complicated by thromboembolic disease. Materials and Methods From October 2005 to December 2009, 107 Bard G2 filters were placed in 106 patients. Forty-eight patients had deep vein thrombosis (DVT) alone, 53 had PE with DVT, and five had PE with no evidence of DVT. After an initial period of anticoagulation with heparin, low-intensity oral anticoagulant therapy to achieve a target International Normalized Ratio of 1.5–2.0 was instituted. Follow-up computed tomography to evaluate the pulmonary circulation, IVC, and lower limbs was performed at 3 and 6 months. Results PE recurred in three of 58 patients (5.2%). None of the 48 patients with DVT alone developed PE, nor was there any recurrence of DVT. The filter was removed in 14 patients (13.2%). No complications occurred during the retrieval procedure. A total of 16 complications occurred in seven patients: one migration (0.9%); four cases of vena cava thrombosis (3.7%), three of which were associated with recurrent PE (2.8%); one filter fracture (0.9%); and one IVC penetration (0.9%). Filter tilting greater than 15° occurred in six patients (5.7%) and was associated with other complications in five (4.7%). Conclusions In patients with malignancies complicated by venous thromboembolic disease, an IVC filter together with low-intensity anticoagulation may be a possible treatment strategy for PE prophylaxis. Controlled studies are warranted.

Abstract No. 350: Changes in tilt angle, position and penetration of inferior vena cava (IVC) wall of ALN, Bard, Cook and Cordis retrievable IVC filters

To determine tilt angle, displacement along IVC and extent of filter penetration of IVC wall by retrievable Cook, Bard, Cordis and ALN IVC filters. The imaging data of all consecutive patients who had Cook, Bard, or ALN inferior vena cava (IVC) filter placed between January 2007 and July 2010, were reviewed retrospectively. The choice of IVC filter placed was at the discretion of the operator, and this study was not randomized. Cases were retrieved by audit of the radiology PACS database. Measurements of tilt angle and position were made using measuring tools in the PACS (InteleViewer) at the insertion, and at the removal. Tilt angle was determined by comparing the long axis of the filter and the long axis of the IVC. Positive tilt angles are to the right. Position of the filter was determined by measuring the distance between venous landmark (caudal end of lowest main renal vein) and the superior tip of the filter. Net tilting and displacement along the IVC was calculated by subtraction of measurements from insertion and retrieval venograms. Furthest penetration caval wall by filter leg was estimated by measurements on retrieval vena cavogram. This study was performed at the 2 adult sites of a large urban academic center, one of which is a Level-1 trauma center. All filter types exhibited some changes in tilt angle, migration and wall penetration. Results are presented in the (Table).Tabled 1Change in tilt angle (degrees) (range)Change in filter apex position (cm) (range)Caval wall penetration by filter (cm) (range)ALN (n=25)0.96 (−16.1 – 18.4)0.37 (−3.65 – 6.5)0.32 (0 – 0.85Bard Recovery & G2 (n=24)4.35 (−7.5 – 23.5)−0.51 (−3.06 – 1.69)0.55 (0 – 1.98)Cook Celect (n=105)0.43 (−19.8–21.0)−0.07 (−4.45–3.31)0.48 (0–1.92)Cook Tulip (n=3)0.77 (−1.5 – 2.9)−0.45 (−1.54 – .36)0.24 (0 – 0.37)Cordis Optease (n=8)1.19 (−7.7 – 13.2)0.72 (−3.6 – 10.0)0.17 (0 – 0.54) Open table in a new tab Four families of IVC filters were compared for various stability characteristics.