Utility of Retrievable Vena Cava Filters and Mechanical Thrombectomy in the Endovascular Management of Acute Deep Venous Thrombosis

Vascular ◽  
2006 ◽  
Vol 14 (5) ◽  
pp. 305-312 ◽  
Author(s):  
Hosam F. El Sayed ◽  
Panos Kougias ◽  
Wei Zhou ◽  
Peter H. Lin
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Mechanical Thrombectomy ◽  
Vena Cava ◽  
Illustrative Case ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Primary Treatment Modality

Endovascular interventions of symptomatic deep venous thrombosis (DVT) using various therapeutic modalities, such as thrombolysis, mechanical thrombectomy, and inferior vena cava (IVC) filter placement, have received increased focus owing in part to advances in catheter-based interventional technologies. Although systemic anticoagulation remains the primary treatment modality in DVT, catheter-based interventions can provide rapid removal of large thrombus burden and possibly preserve venous valvular function in patients with symptomatic DVT. This article reviews current endovascular treatment strategies for acute DVT. Specifically, the utility of mechanical thrombectomy along with various temporary IVC filters in the setting of DVT is examined. Lastly, an illustrative case of acute DVT that was treated with endovascular intervention with IVC filter placement is presented.

Early Technical and Clinical Results with Retrievable Inferior Vena Caval Filters

Vascular ◽  
2004 ◽  
Vol 12 (4) ◽  
pp. 233-237 ◽  
Author(s):  
Russell C. Lam ◽  
Ruth L. Bush ◽  
Peter H. Lin ◽  
Alan B. Lumsden
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hospital Death ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Filters ◽  
Retrievable Ivc Filters

Deep venous thrombosis with or without subsequent pulmonary embolism is a common preventable cause of hospital death. Although anticoagulation is the accepted standard therapy for thromboembolic disease, in situations in which anticoagulation is contraindicated, interruption of the inferior vena cava (IVC) by means of percutaneous placement of a filter has become a widely used alternative. We report our initial experience with two retrievable IVC filters. Between July 2002 and April 2003, 13 patients ( mean age 54 ± 7 years; range 29–75 years) underwent percutaneous placement of either the Gunther Tulip ( n = 5; Cook Inc., Bloomington, IN) or OptEase ( n = 8; Cordis, Miami Lakes, FL) IVC filter. Five patients had filters placed prophylactically before major surgery. The remaining eight patients had had a contraindication to anticoagulation, and three had experienced a hemorrhagic complication as a result of anticoagulation following either a recently documented deep venous thrombosis ( n = 3) or pulmonary embolism ( n = 5). Filters were successfully placed in all 13 patients, with a duration of implantation ranging from 2 to 15 days. Retrieval was attempted in 12 patients (in 1 patient, permanent filtration was secondarily requested) and was achieved in 10 (84.6%) patients. In 2 patients, retrieval failure was due to device angulation within the vena cava precluding safe retrieval. In both instances, the device used was the Gunther Tulip filter. No patient developed symptomatic pulmonary embolism or insertion-site thrombosis following either filter deployment or removal. Trapped thrombus in the filters was seen in all patients. Retrieval required a mean of 6.8 minutes (range 5–10.2 minutes) of fluoroscopy time. Neither filter migration nor caval injury was observed. Temporary IVC filters are effective and are associated with a high retrieval success rate. Further study is warranted to determine the maximal duration of implantation and whether retrievable IVC filters should expand the indications for IVC filter placement.

Perforation of inferior vena cava during filter placement

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Piecuch ◽  
Wiewiora ◽  
Nowowiejska-Wiewiora ◽  
Szkodzinski ◽  
Polonski
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Retroperitoneal Hematoma ◽  
Ivc Filter ◽  
Filter Placement ◽  
Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

Retrievable Inferior Vena Cava Filters Are Rarely Removed

2009 ◽  
Vol 75 (5) ◽  
pp. 426-428 ◽  
Author(s):  
Scott F. Gaspard ◽  
Donald J. Gaspard
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Retrospective Chart Review ◽  
Primary Data ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Successful Removal

There has been an increasing nationwide trend of inferior vena cava (IVC) filter placement over the past 3 years. Most of these have been the newer, removable variety. Although these are marketed as retrievable, few are removed. The purpose of this study was to examine the practice pattern of IVC filter placement at Huntington Hospital. This study is a retrospective chart review of all IVC filter placements and removals between January 1, 2004, and December 31, 2006. The primary data points include indication for placement, major complications (migration, caval thrombosis, pulmonary embolus [PE]), attempted removal, and successful removal. Three hundred ten patients received IVC filters at our institution during this period. Eighty-four were placed in 2004, 95 in 2005, and 131 in 2006. Of those, only 12 (3.9%) were documented permanent filters, whereas the remainder (298) were removable. Of the retrievable filters placed, only 11 (3.7%) underwent successful removal. There were four (1.3%) instances in which the filter could not be removed as a result of thrombus present within the filter and two (0.67%) in which removal was aborted as a result of technical difficulty. Our use of IVC filters has increased steadily over the last 3 years. Despite the rise in use of “removable” filter devices, few are ever retrieved. Although IVC filter insertion appears an effective method of PE prevention, it comes at a cost, both physiological and monetary. It would be wise to devise more stringent criteria to identify those patients in the various populations who truly require filter placement and to be cautious in altering our indications for placement.

scholarly journals A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

2019 ◽  
Vol 4 (01) ◽  
pp. 27-30
Author(s):  
Sandeep T. Laroia ◽  
Justin J. Guan ◽  
Archana T. Laroia ◽  
Lucas Lenhart ◽  
Antony J. Hayes
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Complication Rates ◽  
Ivc Filter ◽  
Filter Placement ◽  
Femoral Access ◽  
Catheter Technique ◽  
Ivc Filters ◽  
Catheter Tip ◽  
A Minor

Abstract Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.

scholarly journals Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Saba S. Shaikh ◽  
Suneel D. Kamath ◽  
Debashis Ghosh ◽  
Robert J. Lewandowski ◽  
Brandon J. McMahon
Keyword(s):  
Inferior Vena Cava ◽  
Cancer Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Absolute Contraindication ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Recurrent Vte ◽  
Clinically Significant

Background. The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives. Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/Methods. A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results. 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions. The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.

Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

2004 ◽  
Vol 17 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Michael K. Rosner ◽  
Timothy R. Kuklo ◽  
Rabih Tawk ◽  
Ross Moquin ◽  
Stephen L. Ondra
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Matched Cohort ◽  
Filter Placement ◽  
High Risk Patients ◽  
Ivc Filters ◽  
Risk Patients

Object The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. Methods In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. Conclusions In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.

Temporary Vena Cava Filters in Oncology Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4247-4247
Author(s):  
Elizabeth H Cull ◽  
Robert Lewandowski ◽  
Brady L Stein ◽  
Brandon McMahon
Keyword(s):  
Cancer Patients ◽  
Vena Cava ◽  
Ivc Filter ◽  
Prospective Data ◽  
Gastrointestinal Malignancies ◽  
Filter Placement ◽  
Advanced Malignancy ◽  
Ivc Filters ◽  
Recurrent Vte

Abstract Background While inferior vena cava (IVC) filter placements continue to exponentially increase, the long-term complications from these devices are progressively more recognized. Randomized data on the efficacy of filters is sparse and focuses mainly on outcomes following permanent filter placement; however, the majority of filters placed currently are retrievable. Placement and removal of these filters are more expensive than permanent filters and have more long-term complications. In this study, we analyzed the use of retrievable filters in the cancer population, a group at very high risk for incident and recurrent venous thromboembolism (VTE). Methods This is a single-institution study. All patients with a history of malignancy or active malignancy that received an interventional radiology (IR) placed temporary IVC filter from 2009 to 2013 were logged into a database. Patients were followed prospectively from time of device placement. Recorded data included demographics, type of malignancy, indication for filter placement, time to filter retrieval, complications of placement/retrieval, rates of VTE recurrence and cause of death (if applicable). Final data analysis (n=179 filter placements) was only performed on patients that had an active malignancy or were receiving adjuvant therapy for a recent active malignancy. Results The most common indications cited for filter placement included a contraindication to anticoagulation (69%), surgical prophylaxis (17%) and concern for cardiopulmonary collapse from a pulmonary embolism (PE) (6%). IVC filters were most frequently placed in patients with underlying hematologic malignancies (28%), gastrointestinal malignancies (17%) and gynecologic malignancies (15%). The majority of patients had stage III or IV cancer (61%). Internal medicine providers were most likely to order filter placements (36%) followed by hematologists/oncologists (26%) and gynecologic oncologists (17%). 35% of filters were not placed due to a contraindication to anticoagulation or failure of anticoagulation, and of these filters placed, 20% were not removed. Of the 179 temporary filters placed, 60% remained permanent. The most common reasons stated for failure of filter removal included: progressive disease/clinical deterioration (51%), continued contraindication to anticoagulation (23%) and loss of follow-up (7%). Only 2% of filters were unable to be removed because of mechanical reasons. Of the 81 attempted filter removals, 5 had in-filter thrombus, 4 had surrounding fiber sheaths, 4 had filter tilt, 1 had IVC in-growth, 1 had a procedure related infection and 1 had broken struts. The rate of recurrent VTE in all patients studied was 20% (predominantly deep vein thromboses), with the majority of recurrences occurring in patients that had the filter in place and were not maintained on anticoagulation. By the end of the study, 59% of patients had died, most commonly due to progressive cancer. Median time from filter placement to death was 5.25 months. Additionally, we gathered data on filter costs. Costs were attributable to the device ($1576.00), placement ($10,983.00) and removal ($8,824.00), totaling over $2 million dollars for placement of IVC filters in this cohort. Conclusions A significant number of cancer patients who have an IVC filter placed have no contraindication to anticoagulation or evidence of recurrent VTE on anticoagulation. Better prospective data is needed regarding the safety and efficacy of IVC filter placement for prophylactic purposes or in the setting of a large VTE burden as these are commonly cited indications for placement. Additionally, consideration for permanent filter placement should be made in cancer patients as the majority of temporary filters are not removed and may carry higher risks of complications. Notably, our filter removal rate was significantly higher than the retrieval rate at most centers (<20%). IVC filters are commonly placed in patients with advanced malignancy and low expected survival, raising particular questions regarding their role in this patient population. Finally, the cost of filter placement and removal is markedly high, further emphasizing the need for better prospective data to clearly delineate those patients who will derive the most benefit from their use. Disclosures Lewandowski: Cook Medical: Consultancy; Boston Scientific: Membership on an entity's Board of Directors or advisory committees. Stein:Incyte Corporation: Honoraria, Speakers Bureau; Sanofi Oncology: Honoraria.

scholarly journals Inferior Vena Cava Filter Placement during Pregnancy: An Adjuvant Option When Medical Therapy Fails

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Sara Valadares ◽  
Fátima Serrano ◽  
Rita Torres ◽  
Augusta Borges
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Vena Cava Filter ◽  
Filter Placement ◽  
Thrombotic Risk

The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.

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