Retrieval Hook Research Articles

Technical Notes on Fluoroscopy-Guided Removal of Metallic Ureteral Stents

This report describes various techniques for fluoroscopy-guided removal of metallic ureteral stents. Fifteen patients underwent 17 fluoroscopy-guided removal procedures of 22 metallic ureteral stents. The simple or modified snare or retrieval hook technique was primarily used for antegrade access, whereas the loop snare technique was primarily used for retrograde access. Overall, 64.7% of the stents were removed using the initial retrieval technique, and 82.4% of the stents were removed using an adjunct technique. Procedure-related complications included hematuria in 41.2% of cases and resolved spontaneously in all patients. Fluoroscopy-guided removal of metallic ureteral stents is safe and effective.

Misplaced (''Missing'') Intrauterine Contraceptive Device Among Clients at a Rural Tertiary Hospital in South Western Nigeria

Background: Misplacement is one of the complications reported with intrauterine contraceptive devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and the mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This was a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 to 31st December 2015. Results: A total of 527 clients were seen at the family planning unit within the period under review. Three hundred and one (301) clients used IUCD, giving a prevalence of 57.1% of total contraceptive use. Of these, 12 IUCDs were reported misplaced, giving the incidence of misplaced IUCDs as 4%. The peak age of the clients reporting misplaced IUCD was 31-40 years. IUCDs insertion during puerperium was seen in 33.4% while most (41.6%) had their IUCD insertion more than 12 months following last childbirth. When considering IUCD insertion in relation to abortion and menses, most (50%) had insertion during menstrual period, 25% had insertion just before the onset of the next menses, postabortal insertion was seen in 16.7% while one (8.3%) could not ascertained the event that preceded the insertion of IUCD. Inability to feel the thread was the commonest presenting complaint in 6 (50%). Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospitals (33.4%). Pelvic examination with uterine sound and abdominal ultrasound were the diagnostic methods commonly used. Most clients (83.3%) missed their IUCDs within the first twelve months of use. Retrieval hook was used for removal in 91.7% of the cases. One (8.3%) had exploratory laparotomy to recover the missing IUCD. Conclusion: Intrauterine devices should be inserted after proper case selection by properly trained medical personnel in both primary and tertiary centres in order to reduce reported cases of missing IUCDs.

The safety and effectiveness of celect inferior vena cava filter evaluated by CT

Objective To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT). Methods CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale. Results All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt>15 degrees in 8 (11.1%) and tilt ≤15 degrees in 34 (47.2%). Caval penetration with 0 grade was observed in 47 (65.3%) and beyond grade 1 was observed in 25 (34.7%), including grade Ⅰ in 12 (16.7%), grade Ⅱ in eight (11.1%), grade Ⅲ in four (5.6%) and grade Ⅳ in one (1.4%). No patient presented with symptoms associated with caval penetration. Filter retrieval was attempted in 54(75.0%) patients,the indwell time was 5.0 to 111.0 days, mean(32.0±23.9) days. There were 52 (96.3%) filters successfully removed, including four filters tilted lead retrieval hook embedded the caval wall, which used the adjunctive retrieval techniques. Filter retrieval failure in two (3.7%) cases, including one case retrieval hook embedded the caval wall and the other with retrieval hook penetration. Conclusions Celect inferior vena cava filter can effectively prevent PE, but had a tendency to tilt and to penetrate caval wall, which affected the filter retrieval, and had the potential risk of serious complications such as abdominal aortic pseudoaneurysm. The filter should be removed as soon as the risk of PE is manageable. We advocate CT follow-up for patients with long-term inferior vena cava filter placement. Key words: Vena cava filters; Venous thrombosis; Lower extremity; Tomography, X-ray computed

Retrievable inferior vena cava filters can always be removed using "fall-back" techniques.

Retrievable inferior vena cava filters (IVCFs) left in place for a prolonged period can lead to complications including filter migration, fracture, and caval thrombosis. "Fall-back" techniques for IVCF retrieval that can be used when standard snaring is unsuccessful have been recently described. The purpose of this study was to analyze how incorporation of these new techniques affected the outcomes of IVCF retrievals at our institution during the past 5 years. Data were collected of all patients undergoing IVCF removal by vascular surgeons at a tertiary academic medical center between 2009 and 2013, including demographics and procedural and filter characteristics. A standard technique of snaring the retrieval hook was attempted first in all cases; if this was unsuccessful, a number of fall-back techniques were employed, including the use of endoscopic graspers, 18F sheaths, and snaring a second wire below the collar of the filter to collapse it into the sheath. IVCF retrieval was attempted in 275 patients; 3 were excluded intraoperatively because of thrombus in the filter. Most filters (97%) were Günther Tulips (Cook Medical, Bloomington, Ind); 70% had been placed prophylactically before bariatric surgery. A total of 268 filters (98.5%) were retrieved successfully, 213 (79%) by standard snaring and 55 (21%) with fall-back techniques. In patients undergoing fall-back techniques, technical success was achieved 100% of the time. The median time since insertion was significantly longer in the fall-back group (173 days vs 83 days; P < .0001). Four intraoperative complications occurred; fractured wires embolized to the right atrium or pulmonary artery and were successfully removed endovascularly. The majority of the procedures (80%) were performed under sedation in both groups. Incorporation of fall-back techniques may allow 100% technically successful and safe removal of retrievable IVCFs and is especially useful in removing filters with prolonged dwell time.

Misplaced IUCD incidence, presentation and complications

INTRODUCTION: Intra uterine contraceptive device is important part of family planning services in India. They can be inserted post menstrually, post abortal, post-delivery or in post puerperal period. Despite of numerous advantages, IUCD is still not easily accepted because of associated complications, like increased bleeding, pain, infection, expulsion, perforation of uterine wall and migration to adjacent organs. MATERIAL AND METHODS: It was a prospective observational cross sectional study carried out in the department of Obstetrics &amp; Gynecology at ESIPGIMSR, Basaidarapur, New Delhi for period of 3 years. All patients referred or presented with lost string or misplaced IUCD were enrolled. RESULTS: In our series, device was found in cervical canal in seven (9.45%) patients while 66 patients had IUCD in uterine cavity. It was removed by curettage or retrieval hook in 54 (72.97%) patients while in 12 (16.21 % ) patients, it was removed by hysteroscope. In one (1.35%) patient, IUCD had migrated to abdominal cavity and required laparoscopy followed by laparotomy, as it was stuck to omentum. CONCLUSIONS: Misplaced IUCDs are a common problem. A regular follow up of IUCDs for visible threads would help in earlier detection of misplaced IUCD and prevent long term consequences. Hysteroscopy will aid both in diagnosing and removal of misplaced IUCD. DOI: http://dx.doi.org/10.3126/jucms.v2i1.10486 Journal of Universal College of Medical Sciences (2014) Vol.2(1): 20-23

Open surgical removal of a tilted and dislodged inferior vena cava filter through a lumbar branch without cavotomy.

Retrievable inferior vena cava (IVC) filters decrease the risk of pulmonary embolism. Retrieval is recommended but device migration, tilting, or perforation of the IVC by the filter may prevent successful removal. We present a case of a tilted IVC filter with the retrieval hook lodged in a lumbar vein preventing endovascular removal. A subcostal incision was used for open removal. The thrombosed lumbar vein was encircled with vessel loops, facilitating collapse of the filter. No cavotomy was made. This technique, with minimal variation, can be used to remove most nonthrombosed retrievable filters from the IVC, without the need for venotomy.

A “fall-back” technique for difficult inferior vena cava filter retrieval

The purpose of this study was to describe the results of an alternative technique for inferior vena cava filter (IVCF) retrieval that can be used when the retrieval hook cannot be snared. Retrospective review of all patients undergoing attempted IVCF retrieval by a single surgeon between March 2009 and March 2011 was undertaken. After December 2009, in cases where the retrieval hook could not be snared, an 18F/85 cm sheath was inserted into the internal jugular vein and a Bentson wire (Cook Medical, Bloomington, Ind) and snare were advanced across separate interstices of the filter. The resulting "lasso" was pulled up below the collar at the top of the filter, and the filter collapsed into the sheath. Over 28 months, 34 patients underwent attempted retrieval of Günther Tulip filters (Cook Medical). Patients were 44±15 years old; 59% were women (n=20). Filters were placed for venous thromboembolism with contraindication to anticoagulation in seven cases and prophylactically in 27 cases. Of the prophylactic cases, 18 (67%) were placed before planned bariatric surgery. Before December 2009, the success rate was 86% (6 of 7): the retrieval hook of one filter could not be snared and seemed to be embedded in the wall of the cava. After adoption of the described technique, the success rate was 96% (26 of 27): one patient refused further attempts at central venous catheterization after multiple unsuccessful attempts. Filters retrieved conventionally by snaring the hook (n=18) were implanted on average for 4.8±3.7 months and 12.1±10.1 months for those retrieved using the new technique (n=14; P=.02). All patients were discharged on the day of the procedure without complication. The one patient in whom the retrieval hook could not be snared before December 2009 has refused another attempt at retrieval. The method of IVCF retrieval described here was successful in every instance in which it was attempted. It was associated with no morbidity despite the customary use of an 18F sheath in the internal jugular vein. The approach constitutes an appropriate "fall-back" technique when the retrieval hook of a removable IVCF cannot be snared.

Introducer Curving Technique for the Prevention of Tilting of Transfemoral Günther Tulip Inferior Vena Cava Filter

ObjectiveTo determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters.Materials and MethodsThe study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval.ResultsThe overall average ACF was 5.8 ± 4.14 degrees. In Group C, the average ACF was 7.1 ± 4.52 degrees. In Group T, the average ACF was 4.4 ± 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 ± 4.59 vs. 5.1 ± 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF ≥ 10°) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, χ2 = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, χ2 = 5.030, p = 0.025).ConclusionThe introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.

Endoscopic Removal of Metallic Airway Stents

Metallic airway stents must be removed when stent-related complications cause airway injury or obstruction. This study compared the techniques and complications associated with endoscopic removal of covered metallic stents (CMSs) and uncovered metallic stents (UCMS). A retrospective analysis of data from 48 patients with airway disorders treated with 40 CMSs and 18 UCMSs, in whom endoscopic stent removal was indicated between January 2005 and January 2010 was carried out. Procedures were performed under general anesthesia with a rigid bronchoscope or local anesthesia with a flexible bronchoscope. The airway wall of 54 stents was pretreated with argon plasma coagulation and/or cryoablation before stent removal. Balloon dilation, argon plasma coagulation, CO2 cryoablation, or chemotherapy was performed to prevent restenoses after the stent removal in selected patients. Of the stents, 84.5% (49 of 58) were eventually removed, including 36 CMSs and 13 UCMSs; 4 CMSs and 5 UCMSs could not be removed. Strut fracture was more common in UCMSs (77.8%) than in CMSs (5%; P<0.001). Of patients with CMS, 91.7% underwent successful removal of intact stents, whereas 92.3% of patients with UCMS were removed damaged or piecemeal. In CMS or UCMS, major complications of stent removal included mucosal tear with bleeding and unveiling of significant granulation tissue from behind the stent. No deaths occurred during the procedure. CMSs can be effectively and safely removed by a flexible bronchoscope with a retrieval hook without major sequelae, whereas UCMSs are very difficult to remove, and complications are very common. Metallic stents should be used only as a last resort in patients with airway disorders.

Percutaneous Transhepatic Treatment of Postoperative Bile Leaks: Prospective Evaluation of Retrievable Covered Stent

Purpose To investigate the technical feasibility and clinical efficacy of a retrievable covered stent for treating postoperative bile leaks. Materials and Methods This is a prospective study conducted from August 2007 to July 2009. Eleven patients with postoperative bile leak involving bilioenteric anastomosis ( n = 8), cystic duct stump ( n = 2), and the right intrahepatic bile duct ( n = 1) were treated using a percutaneous retrievable covered stent. In five patients (45.5%), there were anastomotic ( n = 2) or nonanastomotic ( n = 3) strictures in addition to bile leaks. All of the retrievable covered stents were removed percutaneously by retrieval hook wires. Results Placement and removal of the retrievable covered stents were technically successful in all study patients. The stents were removed 14–64 days (mean, 31 days) after placement. Stent migration occurred in one (9.1%) of 11 patients. After stent removal, clinical success was achieved in all the study patients. Biliary drainage catheters were withdrawn at a mean of 41 days (range, 20–80 days) after percutaneous transhepatic biliary drainage. During the mean follow-up period of 366 days (range, 215–730 days), recurrence was not noted in any patient. Conclusions Placement and removal of a retrievable covered stent is technically feasible and appears to be a clinically effective method for treating postoperative bile leak as well as combined stricture.

Cone over Guide Wire Technique for Difficult IVC Filter Retrieval

Retrievable inferior vena cava (IVC) filters are placed in patients who are at temporary increased risk for pulmonary embolism, with or without contraindication for anticoagulation, with the expectation of subsequent removal. The failure to retrieve nonpermanent IVC filters is an increasingly encountered dilemma for vascular interventionalists. One of the more common causes of technical failure of retrieval is the presence of tilt in the orientation of the IVC filter, which may result in the retrieval hook abutting the wall of the IVC, preventing contact with the removal system [1]. This issue may be compounded by endothelialization of the filter hook [2]. We describe a nonconventional method for the retrieval of tilted IVC filters in two patients. This method uses a femoral access site that is contralateral to the direction of filter tilt in addition to the right internal jugular vein (IJV) access site. A cone-over-guide wire is then used to retrieve the filter, which has been realigned to the caval axis by the gentle application of tension on the guide wire ends. This technique can be used for filters of both the half-basket and double-basket design, when conventional and other nonconventional techniques fail and may make retrieval difficulties pertaining to filter hook endotheliazliation less relevant.

Missing IUD String: Prevalence, diagnosis and retrieval in Nnewi, Nigeria

Displacement of intrauterine contraceptive devices (IUD) is an important complication of this method of family planning and various factors contribute to the risk. We aim in this study to document the prevalence, risk factors, diagnostic methods and treatment of displaced IUD and possible ways of reducing the risk of displacement. A retrospective review of all cases of displaced IUD between 1st January 1995 and December 3st 2004 at Nnamdi Azikiwe University Teaching Hospital and Life specialist hospital limited Nnewi was carried out. The prevalence of displaced IUD was 3.6%. 60.0% of the displacement occurred in women aged 40 years and above; 80% in social class III and above; 60% occurred in grandmultiparous women; 60% of the displaced IUD were inserted more than 6 weeks postpartum. 53.3% of the displacements occurred more than 30 months post insertion. 86.7% of the displacement were into the uterine cavity and into the uterine wall and 66.7% were successfully retrieved by retrieval hook while 66.7% of the clients feared using any other form contraception following the displacement and retrieval. There is the need to further reduce the incidence of IUD displacement by proper insertion technique, retraining of service providers, proper selection of cases and modifications of the IUD.

Günther Tulip and Celect IVC Filters in Multiple-Trauma Patients

To evaluate results with the retrievable Günther Tulip (GT) and Celect inferior vena cava filters (IVCFs) placed at the intensive care unit (ICU) bedside under "real-time" intravascular ultrasound (IVUS) guidance in multiple-trauma patients. Between December 2004 and December 2008, 187 multiple-trauma patients (109 men; mean age 44+/-2 years, range 17-71) with contraindications to low-dose anticoagulation therapy or sequential compression devices had Günther Tulip (n = 97) or Celect (n = 90) retrievable IVCFs placed under real-time IVUS guidance. Günther Tulip filters were inserted using a "double-puncture" technique. The Celect IVCFs were placed with a simplified single-puncture technique in which the filter introducer sheath was advanced until the radiopaque tip "covered" the IVUS image of the renal vein, indicating that the filter sheath was in position for filter deployment. The 2 filter groups were compared on the endpoints of technical implantation success, retrievability, prevention of PE, and procedure-related deep vein thrombosis (DVT). As verified by abdominal radiography, 93.1% (174/187) of IVCFs were placed without complications; 6 IVCFs (all GT; p = 0.03 versus Celect) were misplaced in the iliac vein but uneventfully retrieved and replaced in the IVC within 24 hours. Two insertion site femoral vein DVTs (both in the dual puncture group; p>0.2) and 5 groin hematomas occurred during follow-up. GT filters were in place a mean of 107 days and Celect 97 days. In this time, 2 pulmonary embolisms occurred (1 in each group; p>0.2). Of the 115 filters scheduled for retrieval (50 Günther Tulip, 65 Celect), 33 (23 Günther Tulip, 10 Celect) could not be retrieved (p = 0.0004). Vena cavography identified filter tilting (>20 degrees ) in 21 cases (15 GT, 6 Celect), while 12 filters (8 GT, 4 Celect) had extended indwell times (mean 187 days) and excessive tissue ingrowth covering the retrieval hook. Subjectively, the Celect filters were clinically "easier" to retrieve; they also had fewer cases of significant tilt (>20%) than the GT filters, but the difference was not statistically significant. GT and Celect IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients was simple, safe, and avoided transporting critically ill patients out of the ICU. Further investigation of the single sheath IVUS technique and the role of retrievable IVCFs in multi-trauma patients is warranted.

Laparoscopic Retrieval Of Perforated Intrauterine Device

We present a case of successful laparoscopic retrieval of a perforated intrauterine device (Lippes loop). The Lippes loop was inserted after manual intrauterine adhesiolysis as a treatment of uterine synaechia presenting as secondary amenorrhoea of 20 months duration. The uterine perforation in this patient did not occur at the time of insertion but possibly during the attempt at transcervical removal of the missing IUD by manipulation with the retrieval hook. Double puncture laparoscopic technique under ketamine general anaesthesia was performed to remove the IUD without complication and patient went home the same day.

Response to “Failed Retrieval of an Inferior Vena Cava Filter During Pregnancy Because of Filter Tilt: Report of Two Cases”

I read with interest the recently reported cases of failed retrieval of suprarenally placed inferior vena cava (IVC) filters in two pregnant patients by McConville et al. [1]. We would like to add our experience with a similar case of failed retrieval at our institution recently. A 27-year-old prima gravid woman was referred for removal of a Gunther Tulip filter which had been inserted at another institution 10 weeks earlier at 30 weeks of gestation. The patient had been diagnosed with extensive left-sided iliofemoral deep venous thrombosis and commenced on anticoagulation with low molecular weight heparin. Soon afterward she developed pleuritic chest pain and shortness of breath. The patient refused CT pulmonary angiography because of concerns about radiation exposure and was therefore treated empirically as having incurred a pulmonary embolus. A Gunther Tulip filter was subsequently inserted and positioned in the suprarenal IVC. The patient had a difficult labor 10 weeks later, necessitating a forceps-assisted delivery. She was referred 3 days postpartum for removal of the filter (73 days postinsertion). Preremoval vena cavogram demonstrated a suprarenal position, with no tilt of the cone or malposition of the filter struts. A retrieval set was inserted from the right internal jugular, and the retrieval hook successfully snared. However, it was not possible to fully collapse the struts (Fig. 1), despite applying rotational and torqueing force to the filter using the retrieval system sheath. The patient was complaining of right-sided upper abdominal pain, so no other aggressive maneuvers for removal were applied, as risk of caval rupture or tear was deemed too significant. There is scant published evidence of successful retrieval of temporary suprarenal IVC filters in pregnancy. The sole series, published by Kawamata et al. [2], involved successful retrieval of Neuhaus Protect (Toray Medical, Tokyo) or Antheor (Boston Scientific, Watertown, MA,

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

The purpose of this study was to evaluate the effectiveness of temporary metallic stenting in 55 patients with treatment-resistant benign esophageal strictures and to identify factors associated with clinical outcomes. Under fluoroscopic guidance, covered retrievable stents were placed in 55 patients with benign esophageal strictures and were removed with retrieval hook 1 week to 6 months after placement. Stent placement was successful in all patients, and the mean dysphagia score was reduced from 2.8 to 1.3 (p<0.001). The most common complications were tissue hyperproliferation (31%), severe pain (24%), and stent migration (25%). During follow-up (mean: 38 months), recurrence of the stricture necessitating balloon dilation was seen in 38 (69%) of 55 patients. Maintained patency rates after temporary stenting at 1, 3, and 6 months and 1, 2, and 4 years were 58%, 43%, 38%, 33%, 26%, and 21%, respectively. In multivariate analysis, length (p=0.003) of the stricture was the only significant factor associated with maintained patency after temporary stenting. In conclusion, temporary metallic stenting for refractory benign esophageal strictures may be effective during the period of stent placement, but is disadvantaged by the high recurrence rates after stent removal, particularly in patients with a long length of stricture (>7 cm).

Use of a Retrievable Metallic Stent Internally Coated with Silicone to Treat Airway Obstruction

The authors hypothesized that internally covered stents can reduce the rates of stent migration or mucous retention. The authors performed this study to report their experience with use of a retrievable metallic stent internally coated with silicone in patients with benign or malignant central airway obstructions. From 2004 to 2007, the authors performed fluoroscopically guided placement of a retrievable metallic stent internally coated with silicone in 26 consecutive patients with benign (n = 5) and malignant (n = 21) central airway obstructions. Stents were woven from a single thread of a 0.2-mm-diameter nitinol wire in a tubular configuration and internally covered with silicone membrane. Stent placement was technically and clinically successful in 93% (25/26) and 85% (22/26) of the patients, respectively. There were eight complications (31%) after stent placement, including tumor overgrowth (n = 2), stent migration (n = 1), symptomatic granulation tissue formation (n = 1), severe pain (n = 1), improper stent location (n = 1), symptomatic sputum retention (n = 1) and esophagobronchial fistula (n = 1). Because of complications, five stents were removed with a retrieval hook under fluoroscopic guidance without difficulty. The median survival period and stent patency were 150.0 days +/- 91.4 and 143.0 days +/- 26.7, respectively. The use of a retrievable metallic stent internally coated with silicone is a safe and effective method for relieving dyspnea, with adequate stent patency in patients with benign or malignant central airway obstructions. This stent design seems to be less prone to migration or mucous retention.

Use of Rigid Bronchoscopic Forceps in the Difficult Retrieval of the Günther Tulip Inferior Vena Cava Filter

Retrievable inferior vena cava (IVC) filters may, over time, become incorporated into the wall of the IVC, making subsequent removal difficult. The authors present a case in which a Günther Tulip filter was placed prophylactically before gastric bypass surgery. The retrieval hook of the filter became incorporated into the wall of the IVC, preventing the filter from being snared. Eventually, the filter was freed from the wall of the IVC and successfully removed by using rigid bronchoscopy forceps; however, the filter was damaged in the process.

Retrieval Stent Filter: Treatment of Budd Chiari Syndrome Complicated With Inferior Vena Cava Thrombosis—Initial Clinical Experience

The purpose of this study was to evaluate the initial clinical efficacy of a retrieval stent filter for the management of Budd Chiari syndrome complicated with inferior vena cava thrombosis. The retrieval stent filter consists of two parts (ie, the filter and the Z-stent). The filter was composed of seven legs arranged in the shape of a cone with a retrieval hook at its apex. The filter and the Z-stent were connected with each other, and the retrieval of the stent filter was performed with an Amplatz gooseneck snare (MicroVena [White Bear Lake, MN]). Eight consecutive patients were treated with the stent filters. The stent filter placement was technically successful in all patients. Inferior vena cavography demonstrated that all of the inferior vena cavae were patent without incidental pulmonary embolism after deploying the stent filter. A 3-11 months follow-up study showed that all of the stent filters were removed after approximately 5 to 24 days of placement. All patients were still alive with resolution of the symptoms. The use of a retrieval stent filter proved to be expedient, safe, and effective in the treatment of Budd Chiari syndrome complicated with inferior vena cava thrombosis.

Unsuspected Multiple Intrauterine Contraceptive Devices In An Infertile Woman: A Case Report

A 36 year old Para 1+2 patient presented for infertility management and was found to have 4 intrauterine contraceptive devices loaded apparently in previous attempts at treating intrauterine adhesions. Ultrasound scan revealed that three of the devices were outside the uterus. The patient had no knowledge she had any device on her and had remained infertile for 15 years. The intrauterine device was removed with a retrieval hook while the intraperitoneal devices were identified and removed at laparotomy.