Soft Catheter Research Articles

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Objective: To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). Methods: Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. Results: Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1–3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). Conclusion: Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.

Presternal local analgesia for postoperative pain relief after open heart surgery: A randomized, controlled study

Infiltration of local anesthetics near the surgical wound has shown to improve early postoperative pain in various surgical procedures, especially after open heart surgery. Inadequate pain control reduces the capacity to cough, mobility, increases the frequency of atelectasis, and prolongs recovery. Patients and methods This study is designed to examine the efficacy of postoperative 1 g paracetamol/6 h, ketorolac tromethamine 30 mg/8–12 h as conventional analgesia versus bupivacaine plus magnesium sulfate through a single presternal catheter for postoperative pain relief after cardiac surgery. Forty patients were scheduled for valve replacement cardiac surgeries and were randomly assigned into two groups (20 patients in each group). Group M: each patient has received bupivacaine 0.125% with 5% magnesium sulfate through the presternal soft catheter at a fixed rate of 5 ml/h. Group B: each patient only has received postoperative 1 g paracetamol/6 h, ketorolac tromethamine 30 mg/8 h. For postoperative breakthrough pain, rescue analgesia in the form of 25 μg fentanyl was used, with recording of total required doses in both groups. Results The mean numeric pain scale was significantly lower in group M than in group B at most time points. The overall fentanyl requirements over the first 48 h were significantly lower in group M than in group B (33 ± 11.7 vs. 150 ± 1.6 μg, respectively). There was no statistically significant difference between the two groups regarding ICU stay and blood glucose level. Conclusion Local presternal bupivacaine with magnesium sulfate provided adequate postoperative analgesia and less opioid requirements.

Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns.

Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r2 = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r2 = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r2 = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r2 = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r2 = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r2 = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r2 = 0.0001) than that of the segmental portal vein (115° [105-119]; r2 = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.

Percutaneous Drainage of Abdominal Collections under Imaging Guide

Background: One of the most significant advances in the treatment of intra-abdominal collections during the past 2 decades has been the introduction of image-guided therapy with percutaneous catheter drainage. The development of improved imaging modalities, together with broad-spectrum antibiotics and soft drainage catheters, has changed the treatment of collections that previously required an urgent operation. Disease processes that have traditionally been treated with open surgical drainage and debridement can now be resolved with percutaneous catheter drainage and antibiotics. In selected cases, this will allow for better preparation of the patient for a later elective and definitive operation.Objective: Highlight the outcome, safety and effectiveness of percutaneous drainage procedure of abdominal collections performed under imaging guide.Patients and Methods: Forty one patients were referred from surgical wards and emergency department after diagnosing abdominal collections. Then each case discussed with radiologist to determine the route and type of catheter and imaging modality for guidance (ultrasound and/or computerized tomography). The size and site of the collections were estimated along with the most suitable approach and angle of catheter insertion. A safe drainage route was identified avoiding solid organs and bowel.Results: Percutaneous drainage of 41 abdominal collections under imaging control was carried out in 41 patients during a one year period. No complications resulted from the procedure itself. Percutaneous drainage was sufficient to drain the collections in 35 cases (no further surgery is needed). Of those who require surgery (5 patients), the procedure considered to be as a temporary measure. One case was diagnosed as sero-mucinous tumor of bowel.Conclusion: Percutaneous drainage of abdominal collections is a safe, effective and minimally invasive alternative approach to formal surgical drainage.The advantages include: the drainage can be done under local anesthesia, diagnosis and treatment can be achieved simultaneously in radiological department.

A Simple Technique to Improve Standard Nasotracheal Intubation

NTI is included in the ASA difficult airway algorithm. However, even with the assistance of a Magill forceps, it might be difficult to place the endotracheal (ET) tube in the trachea because of the angle at which the tube approaches the glottis opening and the inability to bend the tube secondary to the ET-tubes compliance. By placing a soft suction catheter thru the ET-tube, and placing the suction catheter into the trachea first and sliding the tube over the catheter this problem can be avoided. In addition, grabbing the suction catheter rather than the ET-tube, also prevents the rupturing of the ET-tube balloon by the Magill forceps.

Complete Genome Sequence of Mycobacterium chelonae Type Strain CCUG 47445, a Rapidly Growing Species of Nontuberculous Mycobacteria.

Mycobacterium chelonae strains are ubiquitous rapidly growing mycobacteria associated with skin and soft tissue infections, cellulitis, abscesses, osteomyelitis, catheter infections, disseminated diseases, and postsurgical infections after implants with prostheses, transplants, and even hemodialysis procedures. Here, we report the complete genome sequence of M. chelonae type strain CCUG 47445.

Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen

BackgroundDuring epidural anesthesia, the catheter tip occasionally deviates from the epidural space into the intervertebral foramen, resulting in inadequate anesthesia.MethodsDuring postoperative plain radiography, iohexol was injected via the epidural catheter to determine its position and to observe the spread of the material. After exclusion of seven patients with catheters that migrated into the subcutaneous area and 25 patients with no evidence of the contrast medium, 415 patients were evaluated. We retrospectively compared patients to determine whether the incidence of deviation into the intervertebral foramen differed between four types of epidural catheters. We also investigated the load applied to the catheter tip using a Shimadzu Autograph AG-X-500 N-111 universal testing machine.ResultsDeviation of the epidural catheter into the intervertebral foramen was observed in eight and 33 patients in the Hakko and Perifix Soft tip catheter groups, respectively. The incidence of deviation was higher in the Perifix Soft tip catheter group, and lower in the FlexTip Plus and Perifix FX catheter groups. A rapid increase was observed in the force exerted on the tips of the Hakko and Perifix Soft tip catheters, while the force transmitted to the tips of the FlexTip Plus and Perifix FX catheters gradually increased and then reached a plateau at a low level.ConclusionsThe incidence of deviation was significantly lower with spiral-type catheters than with other types of catheters. This might be attributable to the gradual transmission of a lower level of force to the tip in spiral-type catheters.

Effect of operation time on efficacy for patients with hypertensive basal ganglia hemorrhage

Two hundred and twenty patients with hypertensive basal ganglia hemorrhage(HBGH)undergoing cranial drilling operation and placement of soft catheter for drainage were enrolled. Among all patiems, the operation was performed at ≤6 h of disease onset in 92 cases (ultra-early group) , 6-24 h in 74 cases (early group) and >24 h in 54 cases (selective group). The surgery-related complications, near-term outcome and long-term outcome were compared among three groups. In ultra-early group, recurrent hemorrhage was observed in 26 cases (28%), which was higher than that in other two groups. In selective group, there were 11 cases (20 %) of well recovered, 19 cases (35%) of moderate deformity, 16 cases (30%) of severe deformity, 5 cases(9%)of vegetative state and 3 fatal cases(6%)indicating that the near-term outcome was worse than those other two groups . However there was no significant difference in long-term outcome among three groups. The rapid minimal invasive cranial drilling and soft catheter drainage is a safe and effective operation for HBGH patients and the optimal time for operation is 6-24 hours. Key words: Cerebral hemorrhage, basal ganglia; Rapid pore cranial drilling; Operation time

Investigation of the invitro photocatalytic antibacterial activity of nanocrystalline TiO2 and coupled TiO2/Ag containing copolymer on the surface of medical grade titanium.

Antibacterial surfaces have been in the focus of research for years, driven by an unmet clinical need to manage an increasing incidence of implant-associated infections. The use of silver has become a topic of interest because of its proven broad-spectrum antibacterial activity and track record as a coating agent of soft tissue implants and catheters. However, for the time being, the translation of these technological achievements for the improvement of the antibacterial property of hard tissue titanium (Ti) implants remains unsolved. In our study, we focused on the investigation of the photocatalysis mediated antibacterial activity of silver (Ag), and Ti nanoparticles instead of their pharmacological effects. We found that the photosensitisation of commercially pure titanium discs by coating them with an acrylate-based copolymer that embeds coupled Ag/Ti nanoparticles can initiate the photocatalytic decomposition of adsorbed S. salivarius after the irradiation with an ordinary visible light source. The clinical isolate of S. salivarius was characterised with MALDI-TOF mass spectrometer, while the multiplication of the bacteria on the surface of the discs was followed-up by MTT assay. Concerning practical relevance, the infected implant surfaces can be made accessible and irradiated by dental curing units with LED and plasma arc light sources, our research suggests that photocatalytic copolymer coating films may offer a promising solution for the improvement of the antibacterial properties of dental implants.

Our technique of preceding diaphragm resection and partial mobilization of the hepatic right lobe using a vessel sealing device (LigaSure™) for huge hepatic tumors with diaphragm invasion.

We describe and assess our technique of preceding diaphragm resection and partial mobilization of the hepatic right lobe to treat a huge hepatic tumor with diaphragm invasion. The right hepatic artery and portal vein were divided at the hepatic hilum, and the mesenteries were then dissected with a vessel sealing device (LigaSure Impact™). The invaded diaphragm was dissected roundly using a vessel sealing device and the right lobe was partially mobilized. A soft catheter was then passed along the anterior aspect of the retrohepatic inferior vena cava and the liver parenchyma was dissected via a liver hanging maneuver. We performed eight hepatectomies using this technique. The median blood loss was 532.5ml and the mean excised liver weight was 1859g. Our results demonstrate the safety and efficiency of the preceding diaphragm resection and partial mobilization technique using a vessel sealing device for right hepatectomy to resect a very large tumor with diaphragm invasion.

Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions

Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.

Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions.

Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.

The effects of different hormonal treatments on the oocyte maturation in wild grey mullet (Mugil cephalus) collected from the Iranian coastal waters of the Oman Sea

To investigate the effects of different hormonal treatments on the oocyte maturation in wild- caught grey mullet ( Mugil cephalus ), fish were subjected to 4 different hormonal treatments as follows: (a) a control group received 0.5 ml/kg B.W. physiological saline, (b) fish injected with 20 mg/kg carp pituitary extract (CPE) as a priming dose followed by 200 µg/kg sGnRHa as resolving dose, (c) fish injected with 200 µg/kg sGnRHa as a priming dose followed by the same injection as a resolving dose and, (d) fish received 20 mg/kg CPE as a priming dose followed by injection of 200 µg/kg sGnRHa in Freund’s incomplete adjuvant emulsion. All GnRHa treated groups received 20 mg/kg B.W. metoclopramide as dopamine antagonist (DA). The interval between two injections was 24 hrs. At 6, 12, 24 and 48 hours post final injection ovarian samples were taken by soft plastic catheter and the maturation of oocytes was examined according to oocyte diameter, position of germinal vesicle and coalescence of oil droplets. The results showed that all hormonal treatments were significantly effective in progression of the oocyte maturation in comparison to control group. The treatments (b) and (d) were more effective than treatment (c) and resulted in final oocyte maturation and germinal break down. It was for the first time that emulsified GnRHa (sGnRHa-FIA) was shown to be effective in final oocyte maturation and ovulation of the species. The results showed that all hormonal treatments were effective in induction of oocyte maturation in wild-caught grey mullet and could be used in commercial hatcheries.

Optimal oocyte retrieval and embryo transfer techniques: where we are and how we got here.

Oocyte retrieval is most safely accomplished with conscious sedation via a transvaginal approach under ultrasound guidance with low-pressure aspiration. Follicle flushing has not been shown to improve outcomes. The type of vaginal surgical preparation and the use of antibiotics have not been demonstrated to affect outcomes. As the final step in a rigorous assisted reproductive technology (ART) cycle, precise technique in embryo transfer is essential. Based on current findings, the recommended embryo transfer technique includes the use of an ultrasound-guided transcervical approach with a full bladder using a soft catheter. The transfer depth of the embryo should be in the mid-portion of the uterus with a quick steady insertion followed by pressure on the syringe during withdrawal of the catheter. It is acceptable to encourage immediate ambulation after embryo transfer.

Can combination of Day 3 and Day 5 embryo morphology be useful to predict pregnancy in in-vitro fertilization cycles?

Objective: To determine whether embryos having all top qualified both on Day 3 and Day 5 have higher pregnancy rates than the others. Materials and Methods: The study included 143 consecutive cycles were recruited in which Day 5 embryo transfer was available. Cleavage stage embryos were graded according to 1 to 4 scoring system, based on fragmentation, cell symmetry, and blastomere number. Among cleavage stage embryos, Grade 1 and Grade 2a/2b were further stratified as ‘top quality’ embryos to be transferred, others were defined as control group. Blastocyst stage embryos were graded from 1 to 6 according to intracellular mass (ICM) and trophectoderm (TE). Day 5 fresh embryo transfer was performed in all cases using soft catheter. Positive pregnancy test was accepted when serum beta-human chorionic gonadotrophin (ß-hCG) exceeded 20 mIU/ml. Results: On the cleavage stage, top quality embryo was available in 47 of 143(32.9%) cases. Of the 47 embryos, the number of cases reaching any Grade 4, 3 quality, and early blastocyst on Day 5 were 22 (46.8%), 15 (31.9%), and 10 (21.3%). The respective figures on the control group (n=96) were 33 (34.4%), 37 (38.5%), and 26 (27.1%) (p > 0.05). The pregnancy rates were also similar. Conclusion: All top qualified embryos both on Day 3 and 5 did not reveal higher pregnancy rate than the others.

Brief history of interventional radiology

In 1923, angiography was first successively used for the human body. In 1953, a Swedish doctor Sven-Ivar Seldinger pioneered the Seldinger technique, which laid down the foundation of interventional radiology. In 1963, Charles Dotter first proposed the idea of interventional radiology. In 1964, Charles Dotter opened a new era of percutaneous angioplasty through accidental operation, marking the formation of interventional radiology. On this basis, the techniques of balloon catheter dilation and metal stent implantation was developed. Endovascular stent was proposed in 1969. In 1973, the percutaneous angioplasty has been a breakthrough with the emergence of soft double-lumen balloon catheter. Percutaneous coronary angioplasty is applied in 1977. Since the 1990s, balloon angioplasty relegated to secondary status with the emergence of metal stent. Currently, endovascular stent have entered a new stage with the emergence of temporary stent and stent grafts and biological stent. Transcatheter arterial embolization had been one of the most important basic techniques for interventional radiology since 1965, it had also been a corresponding development with the improvement of embolic agents and catheter technology for the treatment of diseases now. Transjugular intrahepatic portosystemic stent-shunt is a comprehensive interventional radiology technology since 1967, in which the biliary system can be reached through a jugular vein, and the improvement appeared with balloon expandable stent in 1986.Since 1972, non-vascular interventional techniques was another important branch of interventional radiology. Currently, it is applied in the diagnosis and treatment of many diseases of the internal organs like the pancreas, liver, kidney, spinal cord, Fallopian tubes, esophagus and other organs. In 1973, Chinese radiologist first conducted the angiography test. Interventional radiology was introduced into China in the 1980s, it was readily developed through the sponsoring of training class (1981) and academic conferences (1986). Along with the return of the overseas scholars, the gap in the interventional diagnosis and treatment technology between China and the world has been narrowing since the 1990s.

Diode laser photoablation to correct distal nasolacrimal duct atresia in an adult horse

An 8-year-old Hanoverian mare was presented for chronic mucopurulent discharge in the left eye, which was responsive to topical antibiotic therapy. The nasolacrimal orifice was absent in the left nasal meatum, and anterograde irrigation of left nasolacrimal duct was not possible. Dacryocystorhinography was performed and revealed about 4-6 cm of distal nasolacrimal duct atresia. A novel technique was attempted with the horse under standing sedation using an urinary catheter and a 980 nm diode laser with a 600 μm diameter flexible bare quartz fiber. A nasolacrimal orifice was successfully created by ablating the nasal mucosa directly over the tip of the urinary catheter, and patency was maintained with a soft catheter sutured in place for 4 weeks. At 3 months re-evaluation, the left nasolacrimal duct was patent and functional. This case report describes a successful novel surgical technique used to correct congenital distal nasolacrimal duct atresia in an adult horse under standing sedation. Advantages over conventional surgical techniques are shorter operating time and limited hemorrhage.

Dietary supplementation with tributyrin alleviates intestinal injury in piglets challenged with intrarectal administration of acetic acid

Tributyrin (TBU) is a good dietary source of butyrate and has beneficial effects on the maintenance of normal intestinal morphology. The present study tested the hypothesis that dietary TBU supplementation could alleviate intestinal injury in the acetic acid (ACA)-induced porcine model of colitis. A total of eighteen piglets (25d old) were randomly allocated to one of three treatment groups (control, ACA and TBU). The control and ACA groups were fed a basal diet and the TBU group was fed the basal diet supplemented with 0·1% TBU. On day 15 of the trial, under anaesthesia, a soft catheter was inserted into the rectum of piglets (20-25cm from the anus), followed by administration of either saline (control group) or ACA (10ml of 10% ACA solution for ACA and TBU groups). On day 22 of the trial, after venous blood samples were collected, piglets were killed to obtain mid-ileum and mid-colon mucosae. Compared with the control group, the ACA group exhibited an increase (P<0·05) in lymphocyte counts, creatinine, PGE2, and malondialdehyde concentrations and diamine oxidase and inducible NO synthase activities in the plasma and lymphocyte density in the colon and a decrease in insulin concentrations and glutathione peroxidase activity, ileal villus height:crypt depth ratios and goblet cell numbers in the colon. These adverse effects of ACA were attenuated by TBU supplementation. Moreover, TBU prevented the ACA-induced increase in caspase-3 levels while enhancing claudin-1 protein and epidermal growth factor receptor (EGFR) mRNA expression in the colonic mucosa. Collectively, these results indicate that dietary supplementation with 0·1% TBU alleviates ACA-induced intestinal injury possibly by inhibiting apoptosis, promoting tight-junction formation and activating EGFR signalling.

IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles

BackgroundSome data suggest that the results of human in vitro fertilization (IVF) may be affected by the site of the uterine cavity where embryos are released. It is not yet clear if there is an optimal range of embryo-fundus distance (EFD) within which embryos should be transferred to optimize IVF outcome.MethodsThe present study included 1184 patients undergoing a blind, clinical-touch ET of 1–2 fresh embryos loaded in a soft catheter with a low amount of culture medium. We measured the EFD using transvaginal US performed immediately after ET, with the aim to assess (a) if EFD affects pregnancy and implantation rates, and (b) if an optimal EFD range can be identified.ResultsDespite comparable patients’ clinical characteristics, embryo morphological quality, and endometrial thickness, an EFD between 5 and 15 mm allowed to obtain significantly higher pregnancy and implantation rates than an EFD above 15 mm. The abortion rate was much higher (although not significantly) when EFD was below 5 mm than when it was between 5 and 15 mm. Combined together, these results produced an overall higher ongoing pregnancy rate in the group of patients whose embryos were released between 5 and 15 mm from the fundal endometrial surface.ConclusionsThe site at which embryos are released affects IVF outcome and an optimal EFD range exists; this observations suggest that US-guided ET could be advantageous vs. clinical-touch ET, as it allows to be more accurate in releasing embryos within the optimal EFD range.

Complication of Cystduodenostomy: Stents and the Places They Can Go

Purpose: Endoscopic ultrasound (EUS)-guided translumenal debridement of walled-off pancreatic necrosis (WOPN) has become standard. Although holding an improved safety profile over conventional surgical techniques, mortality is 7.5% and vascular injury is a feared complication. To our knowledge, there have been two reports of pseudocysts involving the inferior vena cava (IVC). First, a pseudocyst eroded into the IVC, forming a fistula. Second, a pseudocyst-causing compression of the IVC. We present an interesting complication of WOPN after treatment with cystduodenostomy. A 66-year-old-male presented with gallstone pancreatitis complicated by a 10.6 cm x 7.1 cm x 15.1 cm WOPN and lower extremity deep vein thrombosis (DVT) status post a Meridian IVC filter (Bard Peripheral Vascular, Tempe AZ). Due to the location of the collection, a cystduodenostomy was performed. After the creation of the ostomy and lavage, 2 10 French 10 cm double pigtail Solis soft flex catheters were placed over a guide wire with fluoroscopic guidance. Twenty-four days later, he presented with fevers. A CT scan with contrast showed a WOPN, and stable thrombosis of the iliac vein and IVC with clot extension 3 cm above the IVC filter, as compared to a CT scan performed one month earlier. Interestingly, the stents extended from the duodenum via WOPN to the IVC and into the left iliac vein. Endoscopy was performed with removal of the previously placed pigtail stents with only self-limited bleeding. The cavity was entered and lavaged. Due to an unfavorable angle, necrosectomy could not be performed. IVC filter wire was seen within the proximal edge of the cyst cavity. Under fluoroscopy, the IVC filter was seen adjacent and intimately associated with the cyst cavity. Post-procedure, he remained stable without bleeding. Communication between the IVC and WOPN are rare. Retrievable IVC filters are reported to penetrate through the IVC wall at a rate of 25% and find their way into many different arteries and the duodenum. Only 10% of these erosions cause clinically significant symptoms. It is unclear if the WOPN eroded into the IVC or if the erosion was a result of endoscopic treatment. During the initial endoscopy, the guide wire must have found its way to the connection with the IVC and down into the iliac veins. Fluoroscopy suggested placement in the lower extension of the fluid collection, although the endoscopist noted that the pigtail catheters didn't curl. Despite placement of the stent into the IVC, bleeding was self-limiting. This is likely due to the chronicity of thrombosis and extensive collateralization. During necrosectomy, the endoscopist should be cognizant of connections that can form between WOPN and IVC.