Permanent IVC filter strut penetration into an abdominal aortic aneurysm

An 85-year-old man with a known history of abdominal aortic aneurysm (AAA) presented to a vascular surgery clinic with a severely swollen, tender and erythematous left leg. An urgent CT angiogram demonstrated a left-sided, proximal deep vein thrombosis, and a permanent, Bird’s Nest inferior vena cava (IVC) filter (Cook, Inc., Bloomington, Ind.) penetrating his AAA. The patient was treated with a course of apixaban 5 mg two times per day and the decision was made to closely observe his IVC filter and AAA, given his numerous comorbidities and age. This case highlights the unique considerations associated with an approach to permanent IVC filter complications among patients with AAAs.

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Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽

10.1182/blood.v118.21.4317.4317 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4317-4317

Author(s):

Mustapha A. Khalife ◽

Vrushali S. Dabak ◽

Marwa Hammoud ◽

Karim Arnaout

Keyword(s):

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Vein Thrombosis ◽

History Of ◽

Group 2 ◽

Deep Vein ◽

Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

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Vascular ultrasound

Point of Care Ultrasound for Emergency Medicine and Resuscitation ◽

10.1093/med/9780198777540.003.0006 ◽

2019 ◽

pp. 117-130

Author(s):

Justin Bowra ◽

Osama Loubani ◽

Paul Atkinson

Keyword(s):

Abdominal Aortic Aneurysm ◽

Deep Vein Thrombosis ◽

Aortic Aneurysm ◽

Vena Cava ◽

Intravascular Volume ◽

Vein Thrombosis ◽

Vascular Ultrasound ◽

Abdominal Aortic ◽

Deep Vein ◽

Intravascular Volume Status

Vascular ultrasound is accurate in the diagnosis of abdominal aortic aneurysm (AAA) and deep vein thrombosis (DVT) at or above the knee. B-mode ultrasound usually suffices to make or refute these diagnoses, although sometimes Doppler ultrasound is required. Vascular ultrasound can also assist in the diagnosis of aortic dissection, although it cannot be used to rule out dissection. Finally, vascular ultrasound is also used to image the inferior vena cava (IVC) to assist in the estimation of intravascular volume status in the shocked patient, usually in conjunction with a shock protocol.

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Retroperitoneal Laparoscopic-Assisted Retrieval of Wall-Penetrating Inferior Vena Cava Filter After Endovascular Techniques Failed: An Initial Clinical Outcome

Vascular and Endovascular Surgery ◽

10.1177/15385744211022517 ◽

2021 ◽

pp. 153857442110225

Author(s):

Haidong Wang ◽

Zhenhua Liu ◽

Xiaofei Zhu ◽

Jianlong Liu ◽

Libo Man

Keyword(s):

Deep Vein Thrombosis ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Endovascular Techniques ◽

Vein Thrombosis ◽

Ivc Filters ◽

Laparoscopic Assisted ◽

Deep Vein

Background: Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed. Patients and Methods: We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months. Results: The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients’ hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence. Conclusions: Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.

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