Significant Caval Penetration by the Celect Inferior Vena Cava Filter: Attributable to Filter Design?

This report describes transmural penetration of the inferior vena cava (IVC) by a newly introduced IVC filter within 9 days of its placement. A computed tomographic study demonstrated filter penetration with one of the primary struts lodging in the uncinate process of the pancreas. Because of the close resemblance of this new filter to another filter that has not been associated with penetration injuries, the key differences between the two designs were examined and the determination was made that the new filter, unlike the older one, has unprotected primary struts. Only filters with an unprotected primary strut design have been associated with penetration injuries such as the one described in this case.     

The Optional VenaTech? Convertible? Vena Cava Filter: Experimental Study in Sheep

Purpose

Retrieval of optional caval filters may be impaired by filter tilting, migration, fracture, or embedding in the IVC wall. The goal of this experimental study was to evaluate a new optional filter, convertible by unlocking and removing the filter head.

Methods

Forty-nine Pre-Alp sheep (average weight, 55?kg) were anesthetized. IVC was catheterized via the right femoral vein (n?=?46) or via the internal jugular vein (n?=?3) with a 12.9-F sheath. VenaTech^? Convertible^? IVC filters were inserted as either permanent filters (n?=?14)?or as filters to be converted. Conversion was immediately after deployment (n?=?19) or delayed after 1, 3, or 6?months (n?=?20). Filter delivery, deployment, and conversion with measurement of migration and tilting were evaluated by cavography. Incorporation of the filter’s stabilizers and arms in the IVC wall was assessed by gross anatomy.

Results

Delivery system insertion, filter release, and immediate conversion were successful in all cases. Delayed conversion was completed in all but one sheep, due to insufficient snare tension. Complimentary balloon-catheter inflation was required in 12 of 20 delayed conversions to achieve filter opening. In all 49 sheep, no thrombosis, migration, or significant tilting occurred. Within 4?weeks of conversion, the filter’s stabilizers and arms were incorporated into the IVC wall. Upon removal, the filter head was free of intimal growth.

Conclusions

The VenaTech^? Convertible^? optional IVC filter was successfully implanted in all sheep with no migration or tilting. Conversion at various dates by filter head removal was feasible in all but one case.     

“Recovery™” Vena Cava Filter: Experience in 96 Patients

The purpose of the study was to assess the clinical safety and efficacy of the “Recovery^TM” (Bard) inferior vena cava (IVC) filter. We retrospectively evaluated the clinical and imaging data of patients who had a “Recovery^TM” IVC filter placed between January 2003 and December 2004 in our institution. The clinical presentation, indications, and procedure-related complications during placement and retrieval were evaluated. Follow-up computed tomography (CT) examinations of the abdomen and chest were evaluated for filter-related complications and pulmonary embolism (PE), respectively. “Recovery” filters were placed in 96 patients (72 males and 24 females; age range: 16–87 years; mean: 46 years). Twenty-four patients presented with PE, 13 with deep vein thrombosis (DVT) and 2 with both PE and DVT. The remaining 57 patients had no symptoms of thromboembolism. Indications for filter placement included contraindication to anticoagulation (n = 27), complication of anticoagulation (n = 3), failure of anticoagulation (n = 5), and prophylaxis (n = 61). The device was successfully deployed in the infrarenal (n = 95) or suprarenal (n = 1) IVC through a femoral vein approach. Retrieval was attempted in 11 patients after a mean period of 117 days (range: 24–426). The filter was successfully removed in nine patients (82%). Failure of retrieval was due to technical difficulty (n = 1) and the presence of thrombus in the filter (n = 1). One of the nine patients who had the filter removed developed IVC thrombus after retrieval and another had an intimal tear of the IVC. Follow-up abdominal CT (n = 40) at a mean of 80 days (range: 1–513) showed penetration of the IVC by the filter arms in 11, of which 3 had fracture of filter components. In one patient, a broken arm migrated into the pancreas. Asymmetric deployment of the filter legs was seen in 12 patients and thrombus within the filter in 2 patients. No filter migration or caval occlusion was encountered. Follow-up chest CT (n = 27) at a mean of 63 days (range: 1–386) showed PE in one patient (3%). During clinical follow-up, 12 of 96 patients developed symptoms of PE and only 1 of the 12 had PE on CT. There was no fatal pulmonary embolism in our group of patients following “Recovery” filter placement. However, the current version of the filter is associated with structure weakness, a high incidence of IVC wall penetration, and asymmetric deployment of the filter legs.     

Percutaneous Endovascular Creation of an Inferior Vena Cava in a Patient with Caval Agenesis,Budd–Chiari Syndrome,and Iliofemorocaval Thrombosis

A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd–Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a “neocava” lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up.     

One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter

Purpose

To prospectively assess the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

Retrograde Tempofilter II? Placement within the Superior Vena Cava in a Patient with Acute Upper Extremity Deep Venous Thrombosis: the Filter Stands on Its Head

The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofilter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis.     

Factors Associated with Advanced Inferior Vena Cava Filter Removals: A Single-Center Retrospective Study of 203 Patients Over 7 Years

Purpose

To identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.

Materials and Methods

A single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine “snare and sheath” technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.

Results

203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.

Conclusions

Women are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times.

     

Evaluation of a Device Combining an Inferior Vena Cava Filter and a Central Venous Catheter for Preventing Pulmonary Embolism Among Critically Ill Trauma Patients

Purpose

To evaluate efficacy and safety of a novel device that combines an inferior vena cava (IVC) filter and central venous catheter (CVC) for prevention of pulmonary embolism (PE) in critically ill patients.

Endovascular Iliocaval Stent Reconstruction for Inferior Vena Cava Filter–Associated Iliocaval Thrombosis: Approach,Technical Success,Safety, and Two-Year Outcomes in 120 Patients

Purpose

To report technical success, outcomes, and patency of iliocaval stent reconstruction for inferior vena cava (IVC) filter–bearing iliocaval thrombosis.