An in situ technique to retrieve an entrapped j-tip guidewire from an inferior vena cava filter

IMPLICATIONS: Entrapment of a guidewire in the vena cava filter during central venous catheter placement is a newly recognized complication. Complex techniques have been described to free the guidewire. We describe a simple in situ technique that may free the guidewire without the application of complex techniques.     

Technique for retrieval of a guidewire lodged in a vena cava filter

A case in which the guidewire used to place a percutaneous jugular central line became entangled in the limbs of a Trapease inferior vena cava filter is presented. A 7F sheath introducer was fashioned into a monorail system to uncurl the wire's J tip and remove the wire without disturbing the filter's position. This report highlights an increasingly frequent clinical scenario and an inexpensive effective method for resolution.     

J-tip spring guidewire entrapment by an inferior vena cava filter

The number of complications between guidewires and inferior vena cava filters is unknown and most likely underreported. Since 1993, at least 17 cases of central venous catheter guidewires entangled in inferior vena cava filters have been reported. The placement of both devices in the intensive care setting has increased the number of incidents in which a guidewire from a central venous catheter becomes entrapped in an inferior vena cava filter. The authors report a case in which entrapment of a guidewire occurred without causing displacement of the filter. In addition, a review of simple but useful recommendations to prevent and manage these complications is presented.     

Endovascular retrieval of an intraaortic greenfield vena cava filter

Aberrant placement of vena cava filters has been documented. Only one case of intraaortic deployment, in which the filter was left at the aortic bifurcation with no adverse effects over a 4-year follow-up period, has been reported. We describe the endovascular retrieval of an intraaortic Greenfield filter using a snare and large sheath to protect the aortic intima from injury during removal of the device.     

Endovascular retrieval of a TrapEase permanent inferior vena cava filter from the aorta

Intra-aortic inferior vena cava filter placement is a rare event. We describe a case in which a permanent vena caval filter was retrieved from the aorta with endovascular techniques. Knowledge of filter design, catheters, and available wires is important to perform this procedure safely.     

困难性下腔静脉滤器取出的初步研究总结

在临床工作中应用广泛的下腔静脉滤器(IVCF)在预防致命性肺栓塞(PE)有着卓有成效的功用.着眼于IVCF的取出,特别是在常规方法不可起到应有的作用时,如何应对IVCF在困难性情况下取出,是临床工作中需要特别关注及思考的问题.针对各种新型IVCF及回收技术,我们应充分熟练掌握新型器械的特点,并了解不同术式的特点及局限性...     

不同回收组套回收超长期时间窗OptEase下腔静脉滤器效果

目的观察Cook回收组套回收超长期时间窗OptEase下腔静脉滤器的效果。方法回顾性分析289例接受OptEase可回收下腔静脉滤器取出术患者,242例于正常时间窗(置入滤器14天内)回收滤器,其中127例(A组)使用OptEase回收组套、115例(B组)使用Cook回收组套;47例于超长期时间窗(滤器置入28天)回收,其中22例使用OptEase回收组套(C组)、25例使用Cook回收组套(D组)。比较A组与B组、C组与D组滤器回收成功率、回收时间及并发症发生率。结果 A、B组均成功回收滤器,2组间滤器回收时间、并发症发生率差异均无统计学意义(P均0.05)。D组滤器回收成功率高于C组(P0.05),回收时间及并发症发生率均低于C组(P均0.05)。各组均未见严重并发症。结论 Cook滤器回收组套用于回收超长期时间窗OptEase下腔静脉滤器效果较好。     

复杂可回收下腔静脉滤器回收的方法和技巧：附29例分析

目的:探讨复杂可回收下腔静脉滤器回收的方法和技巧。方法:回顾性分析29例复杂滤器回收的下肢深静脉血栓形成患者资料。所有患者均先行造影了解滤器情况;对回收钩贴壁患者,分别采用猪尾管支撑技术、导丝成攀及搅拌技术、双向导丝技术、鹅颈抓捕器与成攀导丝结合技术等回收;对下腔静脉继发血栓患者,必要时再次新置滤器1枚,经溶栓、吸栓处理后,将滤器回收。结果:成功回收24例,1例患者滤器未能成功回收,4例放弃,回收率83.9%。术中无下腔静脉破裂出血、肺栓塞并发症,取出滤器完整、无折断现象。至少随访半年,下腔静脉血流通畅、无血栓形成,腹腔无明显积液。结论:导管、导丝及鹅颈抓捕器辅助,溶栓、吸栓等方法可增加复杂可回收下腔静脉滤器回收率,可减少长期留置引起相关并发症。     

Extended indications for placement of an inferior vena cava filter

To study the morbidity and mortality rates after placement of an inferior vena cava filter and to define the appropriate indications for interruption of the inferior vena cava, the records of all patients who underwent insertion of a Greenfield filter during the decade January 1978 to December 1987 were reviewed. Patients were designated as having either a traditional or extended indication for placement of an inferior vena cava filter. Two hundred sixty inferior vena cava filters were placed in 264 attempts, with no deaths related to insertion of the filter. An extended indication was the primary reason for placement of the Greenfield filter in 66 (25%) of the patients. In patients with extended indications there were no cases of air embolism or filter misplacement and only three wound complications (4.5%). Pulmonary embolism after insertion of the inferior vena cava filter occurred in three patients (4.5%), with one fatality (1.5%). Inferior vena cava occlusion was documented in three cases (4.5%), and manifestations of the postphlebitic syndrome in early follow-up were present in two patients (3.0%). As the procedures to prevent fatal pulmonary embolism have become safer, more efficacious, and less morbid, the number of patients in whom the potential benefits of insertion of an inferior vena cava filter outweigh the risks has become larger. Our results support the liberalized use of Greenfield filters in those patients who do not necessarily have one of the traditional indications for placement of an inferior vena cava filter but are at a high risk of having a fatal pulmonary embolus.     

Intraoperative disruption of a Greenfield vena cava filter

A case illustrating fracture and translocation of a Kim-Ray Greenfield filter strut due to intraoperative manipulation of the filter during cholecystectomy is presented. Awareness of this previously unreported complication is essential in preventing its occurrence.     

A prospective evaluation of a bedside technique for placement of inferior vena cava filters: accuracy and limitations of intravascular ultrasound

Our objective was to evaluate the safety and accuracy of a bedside technique for placing vena cava filters with intravascular ultrasonography. We conducted a prospective case series of 36 patients requiring prophylactic vena cava filter placement. Intravascular ultrasound (IVUS) was used to assess the best location for inferior vena cava filter placement. Location of best filter placement was compared with a bedside technique using a fluoroscopic examination. Thirty-six patients underwent an IVUS examination. The 21 men and 15 women had a mean age of 51 years. Our bedside placement technique was successfully performed in 34 patients. Two patients did not undergo a bedside technique because of inadequate imaging. The difference between best filter placement and bedside technique was 1.22 +/- 1.24 cm. In three patients our bedside technique differed from best filter placement by more than 3 cm. Excluding these three patients the difference between best filter placement and bedside technique was 0.92 +/- 0.79 cm. This bedside IVUS technique for placement of inferior vena cava filters is established as safe and accurate; however, knowledge of the limitations involving the technique is important.     

达芬奇机器人手术系统辅助下腔静脉滤器取出术的临床疗效

目的达芬奇机器人手术系统辅助下下腔静脉滤器取出术的临床疗效。 方法采用回顾性描述性研究方法,收集2019年7月陆军军医大学西南医院血管外科收治的亚洲首例行达芬奇机器人手术系统辅助下下腔静脉滤器取出术患者的临床资料。患者下腔静脉滤器置入术后2个月余,血管腔内技术无法取出下腔静脉中的滤器,在达芬奇机器人手术系统辅助下取出下腔静脉滤器。观察指标：术中及术后情况;随访及生存情况。采用门诊进行随访,了解患者术后生存情况。随访时间截至2019年8月。 结果患者成功行达芬奇机器人手术系统辅助下下腔静脉滤器取出术。手术时间326 min,术中出血量100 ml,完成下腔静脉滤器取出术后,下腔静脉切口吻合良好,无出血及狭窄,无术中并发症发生。患者术后住院时间3 d。随访及生存情况：患者术后随访1个月,腹部穿刺套管孔愈合良好,患者生存良好。 结论达芬奇机器人手术系统辅助下下腔静脉滤器取出术安全可行。     

A simple bypass technique for superior vena cava reconstruction

Superior vena cava (SVC) clamping can be required during thoracic surgery for SVC replacement or repair. In such cases, bypass techniques can be necessary to avoid hemodynamic instability, cerebral venous hypertension and hypoperfusion. Here, we report a novel and simple SVC bypass technique which does not require full systemic heparinization, specialized cannulation techniques or pumping devices and which can be applied percutaneously in the preoperative phase or intraoperatively. The preoperative shunt consisted in two Swan-Ganz catheters inserted in the jugular and femoral veins and connected by perfusion tubing with a three way stopcock. The intraoperative shunt consisted of a Pruitt(?)-catheter inserted in the left innominate vein and connected to a femoral Swan-Ganz catheter by perfusion tubing. We validated our system in seven patients undergoing SVC reconstruction. We monitored the systemic arterial blood pressures, the heart rate and vasoactive peptide requirements throughout the procedure. We also determined the neurological status and the in-hospital morbidity and mortality for each patient. Using this bypass, SVC clamping caused no hemodynamic instability, no neurological impairments and no in-hospital complications or deaths. This simple temporary SVC bypass procedure is safe and avoids hemodynamic instability and cerebral venous hypertension.     

A rare complication of the Greenfield vena cava filter

The authors report an unusual case of retroperitoneal haemorrhage following the application of a Greenfield modified titanium filter: haematoma due to the lesion of a lumbar vein was favoured by anticoagulant therapy and complicated by infection, ending in frank disruption of the vein wall. A review is made of the modalities of caval penetration and perforation with the Greenfield filter.