Endovascular removal of an embedded superior vena cava filter after 6 years (original) (raw)
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Journal of vascular surgery. Venous and lymphatic disorders, 2020
Objective: We established a program for retrieval of inferior vena cava (IVC) filters within our hospital system. When percutaneous retrieval fails, we only recommend open surgical removal for symptoms and other complications. We examined our outcomes with conservative management of unsuccessful percutaneous retrieval and open surgical removal for symptomatic/complicated IVC filters. Methods: All patients with history of IVC filter placement who were referred to us for retrieval between 2010 and 2016 were evaluated. Before retrieval, patients were evaluated for risk of future venous thromboembolic events and ongoing need for IVC filtration. Asymptomatic patients with unsuccessful percutaneous filter retrieval were recommended to have annual follow-up with plain abdominal radiographs and to take daily low-dose aspirin. Patients with symptoms referable to the indwelling filter and those with complications were offered open surgical removal. Results: There were 213 patients with a history of IVC filter placement who underwent 220 percutaneous attempts for retrieving 214 IVC filters (four patients had two attempts, one patient had three attempts). Technical success in percutaneously retrieving the filter was 180 of 214 (84.1%) at a median of 5.5 months (interquartile range [IQR], 3.5-9.2) from implant. The median filter dwell time was significantly longer in unsuccessful compared with successful retrieval attempts (8.3 months [IQR, 4.3-15.1 months] vs 5.5 months [IQR, 3.2-8.7 months]; P ¼ .011). Of the 34 filters in 33 patients that could not be retrieved percutaneously, all had either significant filter barb penetration through the caval wall or a tilt angle of greater than 15. The majority of patients (67%) remained asymptomatic without any further complications over a mean follow-up of 24 months (IQR, 12-50 months). No asymptomatic patients developed symptoms or complications over the follow-up period. Two of the five patients who were symptomatic underwent open surgical removal via minilaparotomy. An additional six patients who failed percutaneous retrieval at other institutions were referred to us for open surgical removal owing to symptoms or complications. Technical success for all open surgical removal of IVC filters was 100%. All patients had resolution of their symptoms after percutaneous or open surgical removal. Conclusions: Asymptomatic patients with unsuccessful percutaneous IVC filter retrieval seem to have low complications in midterm follow-up despite significant filter strut penetration. Without symptoms or other complications, such patients do not require referral for open surgical filter removal. Symptomatic patients can expect low morbidity and resolution of symptoms after percutaneous or open surgical removal. Further studies are needed to determine the cost-effectiveness of routinely removing asymptomatic IVC filters.
Long-term Follow-up for Superior Vena Cava Filter Placement
Annals of Vascular Surgery, 2009
The short-term effectiveness and safety placement of superior vena cava (SVC) filter in the treatment of upper extremity deep venous thrombosis in patients with contraindication to anticoagulation have been well documented. However, as opposed to the numerous reported experiences with inferior vena cava filter placement and its complications, there has been no documented long-term follow-up on SVC filter placement. We, therefore, reviewed our experience with SVC filter placement. A retrospective review was performed of the 154 cases of patients who underwent SVC filter placement between January 1994 and August 2005 at our institution. Seven additional patients had unsuccessful SVC filter placement due to widespread deep venous thrombosis. The data were evaluated for both insertion complications (pneumothorax, hemorrhage, filter misplacement) and long-term complications (pulmonary embolism, migration, caval occlusion). The follow-up included review of serial chest radiographs to evaluate for filter migration in patients who lived at least 60 days after filter insertion and had chest radiography performed (n = 40), patients’ charts, clinic visits, and telephone contacts, hospital databases, city death records, and national databases. There were 69 males and 85 females with a mean age of 73.6 years (range, 16−96 years; ±15.3 [SD] years). Follow-up ranged from 1 day to 3750 days (256.3 ± 576 days [mean ± SD]) and 5 patients were lost to follow-up. Of the 154 patients, 58 survived longer than 60 days with mean follow-up of 628.4 days. All SVC filters (TrapEase, n =38; Greenfield, n =116) were successfully deployed in the 154 patients. During the follow-up, 114 (74.0% mortality) of the patients died of chronic illness or from cancer complications. There were three cases of pericardial tamponade (1.9%), and one case of misplaced filter in innominate vein. There were no known cases of symptomatic pulmonary embolism, caval occlusion, pneumothorax, or filter migration. SVC filter placement is associated with a low incidence of complications with long-term follow-up. These data help to reaffirm the safety and effectiveness of SVC filter placement. However, SVC perforation in young males remains a significant issue.
Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters
CardioVascular and Interventional Radiology, 2012
Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long-or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.
Endovascular retrieval of an intraaortic greenfield vena cava filter
Vascular and endovascular surgery
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.
Journal of Vascular and Interventional Radiology, 2010
The present report describes the safe retrieval of caudally migrated optional inferior vena cava (IVC) filters with significant IVC penetration. Three patients had optional IVC filters placed for deep vein thrombosis/pulmonary emboli and contraindications for anticoagulation. Subsequent imaging showed caudal migration and penetration of the filter legs through the IVC wall. All filters were removed without major complications. One patient experienced abdominal pain after filter removal, which required no treatment. Caudal migration of optional filters with IVC wall penetration by the filter legs may be more common with new filter designs in which the secondary and primary struts are separated. J Vasc Interv Radiol 2010; 21:923-926 Abbreviations: DVT ϭ deep vein thrombosis, IVC ϭ inferior vena cava, PE ϭ pulmonary emboli From the
Chest pain from excluded inferior vena cava filter after stent placement
Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2014
A 52-year-old patient presented with chronic substernal chest pain 18 months following exclusion of an inferior vena cava (IVC) filter with a self-expanding IVC stent. After a thorough work-up revealed no other possible cause of chest pain, the filter and stent were removed with subsequent resolution of chest pain. Intraoperatively, filter struts were found to have penetrated the posteromedial wall of the IVC and were abutting the periaortic neural plexus. Referred chest pain due to strut penetration of the caval wall is a novel complication of both IVC filters and IVC stents, demonstrating a need for continued surveillance. (J Vasc Surg: Venous and Lym Dis 2014;2:70-3.) Retrievable inferior vena cava (IVC) filters are an increasingly popular method for short-term prevention of pulmonary emboli from proximal lower extremity deep venous thrombosis (DVT). 1,2 However, 10% to 15% of filters are unable to be endovascularly retrieved, most commonly due to fibrous attachments between filter struts and the IVC wall or significant thrombus in the filter. 3,4 Unretrievable filters increase risks of delayed complications from prolonged dwell time, including device fracture or migration, recurrent DVT, filter thrombosis, guidewire entrapment, and IVC penetration. 5,6 Although IVC penetration is common, clinically significant caval penetration is rare and usually presents with symptoms of back or abdominal pain. 7 The present case highlights a novel complication of IVC filter penetration resulting in unrelenting chest pain.
Journal of vascular and interventional radiology : JVIR, 2017
This report describes the technical feasibility of using the filter eversion technique after unsuccessful retrieval attempts of Option and Option ELITE (Argon Medical Devices, Inc, Athens, Texas) inferior vena cava (IVC) filters. This technique entails the use of endoscopic forceps to evert this specific brand of IVC filter into a sheath inserted into the common femoral vein, in the opposite direction in which the filter is designed to be removed. Filter eversion was attempted in 25 cases with a median dwell time of 134 days (range, 44-2,124 d). Retrieval success was 100% (25/25 cases), with an overall complication rate of 8%. This technique warrants further study.
Retrograde Insertion of Inferior Vena Cava (IVC) Filter: A Bailout Plan
Journal of Surgery Research and Practice, 2023
Venous thromboembolism poses a significant threat to patient health and remains a leading cause of preventable morbidity and mortality. To mitigate the risk of pulmonary embolism resulting from deep vein thrombosis, the insertion of an Inferior Vena Cava (IVC) filter has become a critical intervention. While several approaches are available for IVC filter placement, the internal jugular approach has gained recognition for its unique advantages. This case study provides a comprehensive examination of an 85-year-old female patient who underwent IVC filter insertion through the internal jugular approach with an indication of extensive bilateral iliac venous thrombosis, secondary to femoral vein dialysis catheter. By exploring the clinical experience and outcomes associated with this specific technique, we aim to elucidate the benefits, considerations and potential implications for future practice. Through an in-depth analysis of this case, interventional radiologists, clinicians and healthcare professionals involved in venous thromboembolism management can gain valuable insights into the safety, efficacy and patientcentered outcomes of the internal jugular approach for IVC filter insertion.