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Title: Failed Retrieval of Potentially Retrievable IVC Filters: A Report of Two Cases

Abstract

Retrievable inferior vena cava filters are being increasingly used for the prevention of life-threatening pulmonary emboli in patients who have temporary contraindications to anticoagulation therapy. We report two cases of failure to remove these devices.

Authors:
 [1]; ;  [2]
  1. Queen's Medical Centre, Department of Radiology (United Kingdom), E-mail: anil.kumar@doctors.org.uk
  2. Ninewells Hospital, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
21091283
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-005-0145-6; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EMBOLI; FAILURES; FILTERS; PATIENTS; THERAPY; VASCULAR DISEASES

Citation Formats

Kumar, Bangalore C. Anil, Chakraverty, Sam, and Zealley, Ian. Failed Retrieval of Potentially Retrievable IVC Filters: A Report of Two Cases. United States: N. p., 2006. Web. doi:10.1007/S00270-005-0145-6.
Kumar, Bangalore C. Anil, Chakraverty, Sam, & Zealley, Ian. Failed Retrieval of Potentially Retrievable IVC Filters: A Report of Two Cases. United States. doi:10.1007/S00270-005-0145-6.
Kumar, Bangalore C. Anil, Chakraverty, Sam, and Zealley, Ian. Wed . "Failed Retrieval of Potentially Retrievable IVC Filters: A Report of Two Cases". United States. doi:10.1007/S00270-005-0145-6.
@article{osti_21091283,
title = {Failed Retrieval of Potentially Retrievable IVC Filters: A Report of Two Cases},
author = {Kumar, Bangalore C. Anil and Chakraverty, Sam and Zealley, Ian},
abstractNote = {Retrievable inferior vena cava filters are being increasingly used for the prevention of life-threatening pulmonary emboli in patients who have temporary contraindications to anticoagulation therapy. We report two cases of failure to remove these devices.},
doi = {10.1007/S00270-005-0145-6},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 29,
place = {United States},
year = {Wed Feb 15 00:00:00 EST 2006},
month = {Wed Feb 15 00:00:00 EST 2006}
}
  • No abstract prepared.
  • Thromboembolic disease during pregnancy is an important cause of obstetric morbidity and mortality. Pregnant patients with venous thromboembolism are usually managed by conventional anticoagulation. However, this must be discontinued during vaginal or caesarian delivery to avoid haemorrhage and to reduce the risk of possible epidural haematoma. Retrievable inferior vena cava filters (IVCFs) offer protection against pulmonary embolism during this high-risk period, when anticoagulation is discontinued, while avoiding potential long-term sequelae of a permanent IVCF. Here we report two patients who presented in the third trimester of pregnancy with floating ileofemoral deep vein thrombosis. Both patients were initially treated with standardmore » anticoagulation; however, shortly before delivery both patients had a retrievable IVCF placed in a suprarenal position. In both patients, retrieval failed at 28 days after insertion because of filter tilt. The timing and mechanism of filter tilt remains uncertain. We believe that a number of factors could have been involved, including change in the anatomic configuration with lateral displacement of the IVCF as a result of the gravid uterus as well as forceful uterine contractions during labour, which modified the shape and diameter of the IVC. We showed that failure to retrieve the IVCF has had considerable implications for the two young patients regarding long-term anticoagulation and have highlighted the need for further clinical trials regarding the safe use of retrievable IVCFs during pregnancy.« less
  • Purpose: This study was designed to assess the incidence, magnitude, and impact upon retrievability of vena caval perforation by Guenther Tulip and Celect conical inferior vena cava (IVC) filters on computed tomographic (CT) imaging. Methods: Guenther Tulip and Celect IVC filters placed between July 2007 and May 2009 were identified from medical records. Of 272 IVC filters placed, 50 (23 Guenther Tulip, 46%; 27 Celect, 54%) were retrospectively assessed on follow-up abdominal CT scans performed for reasons unrelated to the filter. Computed tomography scans were examined for evidence of filter perforation through the vena caval wall, tilt, or pericaval tissuemore » injury. Procedure records were reviewed to determine whether IVC filter retrieval was attempted and successful. Results: Perforation of at least one filter component through the IVC was observed in 43 of 50 (86%) filters on CT scans obtained between 1 and 880 days after filter placement. All filters imaged after 71 days showed some degree of vena caval perforation, often as a progressive process. Filter tilt was seen in 20 of 50 (40%) filters, and all tilted filters also demonstrated vena caval perforation. Transjugular removal was attempted in 12 of 50 (24%) filters and was successful in 11 of 12 (92%). Conclusions: Longer indwelling times usually result in vena caval perforation by retrievable Guenther Tulip and Celect IVC filters. Although infrequently reported in the literature, clinical sequelae from IVC filter components breaching the vena cava can be significant. We advocate filter retrieval as early as clinically indicated and increased attention to the appearance of IVC filters on all follow-up imaging studies.« less
  • We describe our experience with the use of the 'double-wire restraining' technique to assist in the removal of two retrievable inferior vena cava filters: one had been misplaced in the right brachiocephalic vein with apex perforation of the vessel wall, and the second filter had migrated cephalad to straddle across both renal veins. The 'double-wire restraining' technique consists of two stiff-shaft Glidewires (Terumo, Somerset, NJ) placed through the same introducer sheath and positioned on opposite sides of the filter. Both wires restrain the filter at the tip of the sheath as the sheath is advanced, thus allowing the operator tomore » reposition the filter. This report details how this technique was used to realign two malpositioned filters and reposition the filter apices from their extravascular location, thus exposing them for ensnarement.« less
  • Purpose: We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. Methods: We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications frommore » long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. Results: Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Guenther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. Conclusion: Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.« less