Inferior Vena Cava Penetration Research Articles

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.

Retrievable Filters: Maximizing Retrieval Rates

c w f t t w t p t g r p a s f p c t The use of permanent inferior vena cava (IVC) filters is effective in the prevention or reduction of pulmonary embolism (PE) in patients with contraindications to anticoagulation or in patients who have failed anticoagulation.1-3 Risks of permanent filters are well known, including fracture, IVC penetration, symptomatic IVC thrombosis, and development of deep venous thrombosis (DVT).4 Retrievable filters llow for short-term filtration and thus avoid long-term comlications in patients who are only temporarily at risk for the evelopment of PE. The Gunther Tulip filter (GTF; Cook, nc, Bloomington, IN) was the first to be introduced in the arly 2000s in the United States. Since then, use of retrievable lters has increased, with relatively low complications and ood efficacy in the prevention of PE.5-9 However, their use has been hampered by slightly greater cost and lack of longterm follow-up compared with permanent filters. Although indications for filter use have expanded, there are authors who believe this in not supported by evidence.10 Several filters are approved for use (Fig. 1, Table 1). The design of retrievable filters is driven by the opposing duality of ease of long-term retrieval on the one hand and stability of the device against migration and penetration or perforation on the other. These 2 forces appear at times diametrically opposed as demonstrated by the performance of the GTF and the Recovery filter, 2 of the first filters approved for retrieval. The GTF has fewer issues with penetration and migration but because of significantly more wall contact of the secondary struts and resulting incorporation, it has lower retrieval rates after longer dwelling times of 6 months or more. The Recovery filter, by contrast, had issues with migration and yet seemed to have fewer problems with longterm retrieval.

Surgical Management of Inferior Vena Cava Strut Penetration Causing Hydronephrosis: Case Report

We present a case of penetration of inferior vena cava (IVC) by primary struts of Cook Celect filter and impingement on right ureter, causing symptomatic hydronephrosis and hydroureter, which was managed surgically by ureterolysis, mobilization of the ureter by retroperitoneal approach, excision of the filter strut, and omental wrap around the ureter.

Hydronephrosis caused by Inferior Vena Cava Penetration by a Mobi-nuddin 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.

Retrievability of Optional Inferior Vena Cava Filters with Caudal Migration and Caval Penetration: Report of Three Cases

The present report describes the safe retrieval of caudally migrated optional inferior vena cava (IVC) filters with significant IVC penetration. Three patients had optional IVC filters placed for deep vein thrombosis/pulmonary emboli and contraindications for anticoagulation. Subsequent imaging showed caudal migration and penetration of the filter legs through the IVC wall. All filters were removed without major complications. One patient experienced abdominal pain after filter removal, which required no treatment. Caudal migration of optional filters with IVC wall penetration by the filter legs may be more common with new filter designs in which the secondary and primary struts are separated.

Late complication from a retrievable inferior vena cava filter with associated caval, aortic, and duodenal perforation: A case report

Inferior vena cava filters are an excellent therapeutic method for those patients in whom anticoagulant therapy is contraindicated or ineffective. However, filter placement is associated with a high rate of serious complications (>30%), with death occurring in 3.7% of patients. The most common complication is an asymptomatic inferior vena cava penetration and perforation. In some rare circumstances, however, therapeutic intervention may be required because of perforation of adjacent organs. We report a clinical case of a patient with simultaneous caval, duodenal, and aortic perforation resulting from penetration of inferior vena cava filter hooks. A brief review of the literature discusses presenting symptoms and treatment of such rare complications.

Retroperitoneal Hematoma After Inferior Vena Cava Filter Insertion

Inferior vena cava (IVC) filter placement has been shown to have excellent therapeutic efficacy and low complication rates in selected patients with deep venous thrombosis and pulmonary embolism. We report a case of IVC penetration by filter struts that resulted in a near-fatal retroperitoneal hemorrhage. An 83-year-old woman was admitted with left femoral deep venous thrombosis. Abdominal computed tomography showed a double IVC, and the left IVC had a massive thrombus …

Caval Penetration with Retroperitoneal Hemorrhage Following Placement of an Inferior Vena Cava (IVC) Filter

Placement of inferior vena cava (IVC) filters is an increasingly common request at our institution. The rise in utilization of caval filtration is probably multifactorial and includes pulmonary embolism (PE) prophylaxis most notably in the setting of trauma, the approval and widespread use of temporary/removable filters, and the perceived low complication rates associated with new generation filter designs. We present a unique case of IVC penetration by a new generation filter that resulted in a retroperitoneal hemorrhage in a fully anticoagulated patient.

Guidelines on use of vena cava filters

Summary of key recommendations • VC filters are indicated to prevent pulmonary embolus(PE) in patients with venous thromboembolism (VTE)who have a contraindication to anticoagulation (grade B,level III).• Anticoagulation should be considered in patients with aVC filter when a temporary contraindication to antico-agulant therapy is no longer present. Insufficient dataexists to support a recommendation that all filter recip-ients should be treated with indefinite anticoagulationregardless of their risk of recurrent thrombosis (grade C,level IV). The decision as to whether or not to introduceanticoagulant therapy should be based on the perceivedunderlying thrombotic risk of the condition and thelikelihood of anticoagulant therapy-related bleeding.• VC filters are not indicated in unselected patients withVTE who will receive conventional anticoagulant therapy(grade A, level Ib).• VC filter insertion may be considered in selected patientswith PE despite therapeutic anticoagulation. Alternativetreatment options, such as long-term high-intensity oralanticoagulant therapy [international normalised ratio(INR) target 3AE5] or low molecular weight heparin(LMWH), should be considered prior to VC filterplacement, particularly in patients with thrombophilicdisorders (e.g. antiphospholipid syndrome) or cancer(grade C, level IV).• VC filter insertion may be considered in pregnantpatients who have contraindications to anticoagulationor develop extensive VTE shortly before delivery (within2 weeks). Retrievable filters should be considered (gradeC, level IV).• Free-floating thrombus is not an indication for insertionof a VC filter (grade B, level III).• Thrombolysis is not an indication for filter insertion. If afilter is used a retrievable filter should be used if available(grade C, level IV).• VC filters should be considered in any pre-operativepatient with recent VTE (within 1 month) in whomanticoagulation must be interrupted. Retrievable VCfilters should be considered in this situation where atemporary contraindication to anticoagulation exists(grade C, level IV).• No particular filter appears superior to others. Removablefilters should be used, if available, for patients with ashort-term contraindication to anticoagulant therapy(e.g. approximately 2 weeks) (grade C, level IV).

Delayed Transcaval Renal Penetration Of A Greenfield Filter Presenting As Symptomatic Hydronephrosis

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Apr 2002Delayed Transcaval Renal Penetration Of A Greenfield Filter Presenting As Symptomatic Hydronephrosis A.L. Jackson Slappy, R.J. Kennedy, A.G. Hakaim, R.O. Parra, and W.A. Oldenburg A.L. Jackson SlappyA.L. Jackson Slappy More articles by this author , R.J. KennedyR.J. Kennedy More articles by this author , A.G. HakaimA.G. Hakaim More articles by this author , R.O. ParraR.O. Parra More articles by this author , and W.A. OldenburgW.A. Oldenburg More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65199-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Delayed Transcaval Renal Penetration Of A Greenfield Filter Presenting As Symptomatic Hydronephrosis." The Journal of Urology, 167(4), pp. 1778–1779 References 1 : Percutaneous inferior vena caval filters: follow-up of seven designs in 320 patients. Radiology1993; 188: 614. Google Scholar 2 : Symptomatic hydronephrosis caused by inferior vena cava penetration by a Greenfield filter. J Vasc Interv Radiol1996; 7: 99. Google Scholar 3 : Ureteral injury secondary to an inferior vena caval filter. J Urol1996; 156: 1763. Link, Google Scholar From the Departments of Surgery, Vascular Surgery and Urology, Mayo Clinic, Jacksonville, Florida© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 167Issue 4April 2002Page: 1778-1779 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordshematuria, flank pain, hydronephrosisvena cava, inferiorvena cava filtersMetricsAuthor Information A.L. Jackson Slappy More articles by this author R.J. Kennedy More articles by this author A.G. Hakaim More articles by this author R.O. Parra More articles by this author W.A. Oldenburg More articles by this author Expand All Advertisement Loading ...

Clinical evaluation of inferior vena cava filters in patients with deep vein thrombosis

The titanium Greenfield filter (TGF) is widely accepted for its efficacy, high patency, and low complication rate. Between November 1998 and April 2000, six patients underwent placement of titanium Greenfield filters at Tokoro Memorial Hospital. Three patients were at high risk for pulmonary embolism (PE), two were at risk for anticoagulation therapy, and, one had a proven PE. One patient died 9 months after filter insertion from a cerebral hemorrhage. Inability to pass the pelvic vein via the left femoral vein was encountered in one case at the time of placement. Plain abdominal films revealed that filter angulation (off-axis position) was confirmed in four cases. Two cases of filters were well centered in the inferior vena cava (IVC). The mean angulation was 6 ± 2.3 degrees. The plain radiographic appearance of the filter suggested asymmetric distribution of the filter struts in four cases. Four cases were examined by plain abdominal computed tomography (CT), and IVC penetration was recognized in all cases. Clinically relevant recurrent PE, cephalad or caudal migration, changes of filter span, and mechanical fracture of the strut were not recognized after TGF placement. Problems of angulation, penetration of the IVC wall, and asymmetric distribution of the filter struts were observed, but all patients were asymptomatic after filter insertion. In the future, more cases need to be studied for a better evaluation of late complications.

Percutaneous Placement of Bird's Nest Inferior Vena Cava Filter

Purpose : To describe clinical experiences of the use of Bird’s Nest inferior vena cava(IVC) filter. Materials and Methods : Between August 1991 and August 1997, IVC filter was percutaneously inserted in 51 patients with pulmonary embolism(PE) and deep vein thrombosis of the lower extremities. Indications for the placement of this filter were contraindication to anticoagulation in 17 patients, prophylaxis of PE in 17, failed anticoagulation in 11, massive PE with residual floating thrombus in three and complications involving anticoagulation in 3. In order to delineate the location of renal vein and extension of deep vein thrombosis into the IVC, all patients under went inferior vena cavography before filter placement. Thirty filters were inserted through the right femoral vein, 19 through the right internal jugular vein and three through the left femoralvein. The patients involved were followed up for periods ranging from one week to six years (mean, 10 months).Results : A Bird’s Nest IVC filter was placed in the infrarenal IVC in 44 patients and in the suprarenal IVC in7. Certain complications ensued. IVC penetration occurred in three patients(5.9%), and in seven(1.37%) the filter wire prolapsed. Except for transient pain, however, there were no serious IVC penetration-related complication sand no evidence of recurrence of PE in the cases involving prolapse of the filter wire. During follow up, clinically suspected recurrent PE was noted in two patients(3.9%), but there was no evidence of newly developed occlusion of the IVC. Conclusion : In patients who under went follow up, Bird’s Nest IVC filter effectively prevented the development and recurrence of PE, and there were no complications. To prevent of penetration of the IVC and prolapse of the filter, however, technical skill was needed.