Median Implantation Time Research Articles

Outcomes with Retrievable Inferior Vena Cava Filters: A Multicenter Study

To retrospectively review the outcomes after placement and retrieval of retrievable inferior vena cava (IVC) filters at two academic medical centers. All patients who underwent retrievable filter placement between May 2001 and December 2005 were included. Hospital records at both institutions were reviewed, and relevant data were collected concerning the placement and retrieval of all removable filters. A total of 197 patients underwent placement of a retrievable IVC filter. Of those, 143 patients (72.5%) had Günther Tulip filters (GTFs) placed, and 54 patients (27.5%) had Recovery filters placed. A total of 94 patients underwent attempted filter retrieval, accounting for just less than half of all retrievable filters placed during the study period (47.7%). Retrievals were successful in 80 patients (85.1%). Half the retrieval failures (n = 7) were the result of thrombus within the filter, and technical difficulties (eg, filter embedded in IVC wall, tilted filter) were the cause of retrieval failure in the other half. There was no significant difference in retrieval failure rates between the GTF and Recovery filter (16.4% vs 9.5%, respectively). GTFs were removed after a median implantation time of 11 days (range, 1-139 d), whereas Recovery filters were removed after a median implantation time of 28 days (range, 6-117 d). Placement and retrieval of nonpermanent IVC filters can be performed safely with a high technical success rate. In patients at high risk for venous thromboembolism and contraindication to anticoagulation, retrievable filters may be used aggressively to prevent the potentially devastating outcome of pulmonary embolism.

Prevalence of Rupture in Inamed Silicone Breast Implants

Silicone breast implants have been used for decades and are arguably the most studied implantable device. However, the vast body of scientific literature has been unable to establish a definitive rupture rate. Various studies have evaluated implant rupture, but the meaningfulness of these data was confounded by the inclusion of different generations of implants and multiple manufacturers' implants and the selection of subjects who were already suspected of having ruptured implants. The authors' study was designed to acquire long-term rupture data specific to Inamed's third-generation silicone breast implants using magnetic resonance imaging technology. A total of 106 women with at least one Inamed silicone breast implant (styles 40, 110, and 120) were enrolled in this multicenter, cross-sectional study. The majority received implants for cosmetic augmentation (n = 77, 72.6 percent), with a smaller number having undergone breast reconstruction (n = 11, 10.4 percent) or revision of previous breast implant operations (n = 18, 17.0 percent). Most subjects were Caucasian (n = 99, 93.4 percent) with a median age at implantation of 34 years (range, 18 to 70 years). Enrolled subjects underwent a physical examination and magnetic resonance imaging screening at one of five sites to determine the prevalence of asymptomatic rupture. A total of 199 implants were evaluated, with a median implantation time of 10.9 years (range, 9.5 to 13.2 years). Overall, 183 implants (92.0 percent) showed no evidence of rupture, 12 (6.0 percent) showed evidence of rupture, and four (2.0 percent) were indeterminate. All indeterminate evaluations were considered ruptures, providing a worst-case rupture prevalence of 8.0 percent. The study results establish a rupture prevalence rate of 8.0 percent at 11 years for Inamed's silicone breast implants.

Extended Interval for Retrieval of Günther Tulip Filters

To evaluate the Gunther Tulip vena cava filter with regard to ease of placement, complications, and retrieval over long time periods. In 53 patients (ratio of men to women, 24:29; mean age, 52.8 years) retrievable Gunther Tulip filters (Vena Cava M Reye Filter Set; William Cook Europe, Denmark) were inserted. Indications included planned major surgery with recent pulmonary embolus or high pulmonary embolus risk (n = 16), extensive ilio-femoral thrombus (n = 11), deep vein thrombosis with anticoagulant complications (n = 9), breakthrough pulmonary embolus despite anticoagulant therapy (n = 4), and contraindication to anticoagulant therapy (n = 13). All patients were followed-up for immediate and long-term complications. Fifty-three filters were successfully placed in 52 of 53 patients, yielding a success rate of 98.1%. Nineteen patients underwent attempted retrieval of their filter. Sixteen of 19 retrieval procedures were successful (84%). In three patients, the filter could not be removed on attempted retrieval (extensive filter thrombus in two patients and attachment to the wall in one patient). One patient received two filters, which were both successfully retrieved at a later date. Median implantation time for retrievable filters was 34 days (range, 7-126 days). Mean follow-up for patients with permanent filters was 13 months. Two major complications (pneumothorax and break through pulmonary embolus) and three minor complications (right internal jugular vein thrombosis in two patients and transient Horner's Syndrome in one patient) were recorded. Insertion and retrieval of filters is safe and feasible. Preliminary data suggest that Gunther Tulip filter retrieval is feasible over and above the manufacturer's recommended retrieval interval of 14 days.

Capsulotomy Rate in Silicon Plate Haptic and Prolene Loop IOLs

OBJECTIVE: To compare the incidence of YAG posterior capsulotomy between eyes' implanted with silicone prolene loop and plate haptic lenses, and to compare the incidence of posterior capsulotomy in the short-term (median implantation time of 10.5 months) and long-term (median implantation time of 30 months) in the patients implanted with the plate haptic lens. STUDY DESIGN: Retrospective study comparing the incidence of capsulotomy in patients from Anaheim Eye Medical Group having undergone outpatient cataract surgery by the same surgeon using endocapsular phacoemulsification and implantation with capsulorhexis with an intact anterior capsular rim and bag. PATIENTS: Two groups of plate haptic silicone lens implanted patients, one group of 141 and another of 301 patients, were compared to 253 patients implanted with the prolene loop silicone lens over the same implantation and follow-up times. In the second part of the study, 503 patients were studied. Of the 442 patients with a median follow-up time of 10.5 months, five had capsulotomies. The remaining 498 patients had a median implantation time of 30 months with a capsulotomy rate of 1.4%. RESULTS: The incidence of posterior capsulotomy in patients implanted with silicone plate haptic lenses was 1.1% with a median implantation time of 10.5 months compared to 7.1% in the prolene loop group with a median implantation time of 12 months (significance level of <0.0001). The incidence of capsulotomy in the plate haptic group with a median implantation time of 10.5 months was 1.1% and those with a median implantation time of 30 months was 1.4%, indicating a reduction in the rate of capsulotomy in the long term. CONCLUSIONS: The incidence of capsulotomy is lower in silicone plate haptic lenses when compared to silicone prolene loop lenses. The low incidence of capsulotomy in plate haptic lenses decreases with the passage of time.