scholarly journals Use and Removal of Inferior Vena Cava Filters in Patients With Acute Brain Injury

2020 ◽  
Vol 10 (3) ◽  
pp. 188-192
Author(s):  
Kara Melmed ◽  
Monica L. Chen ◽  
Mais Al-Kawaz ◽  
Hannah L. Kirsch ◽  
Andrew Bauerschmidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Inferior Vena ◽  
Vena Cava ◽  
Acute Brain Injury ◽  
Ivc Filter ◽  
Medicare Beneficiaries ◽  
Filter Placement ◽  
Risk Of Mortality ◽  
Reduced Risk

Background: Few data exist regarding the rate of inferior vena cava (IVC) filter retrieval among brain-injured patients. Methods: We conducted a retrospective cohort study using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients aged ≥65 years who were hospitalized with acute brain injury. The primary outcome was the retrieval of IVC filter at 12 months and the secondary outcomes were the association with 30-day mortality and 12-month freedom from pulmonary embolism (PE). We used Current Procedural Terminology codes to ascertain filter placement and retrieval and International Classification of Diseases, Ninth Revision, Clinical Modification codes to ascertain venous thromboembolism (VTE) diagnoses. We used standard descriptive statistics to calculate the crude rate of filter placement. We used Cox proportional hazards analysis to examine the association between IVC filter placement and mortality and the occurrence of PE after adjustment for demographics, comorbidities, and mechanical ventilation. We used Kaplan-Meier survival statistics to calculate cumulative rates of retrieval 12 months after filter placement. Results: Among 44 641 Medicare beneficiaries, 1068 (2.4%; 95% confidence interval [CI], 2.3%-2.5) received an IVC filter, of whom 452 (42.3%; 95% CI, 39.3%-45.3) had a diagnosis of VTE. After adjusting for demographics, comorbidities, and mechanical ventilation, filter placement was not associated with a reduced risk of mortality (hazard ratio [HR], 1.0; 95% CI, 0.8-1.3) regardless of documented VTE. The occurrence of pulmonary embolism at 12 months was associated with IVC filter placement (HR, 3.19; 95% CI, 1.3-3.3) in the most adjusted model. The cumulative rate of filter retrieval at 12 months was 4.4% (95% CI, 3.1%-6.1%); there was no significant difference in retrieval rates between those with and without VTE. Conclusions: In a large cohort of Medicare beneficiaries hospitalized with acute brain injury, IVC filter placement was uncommon, but once placed, very few filters were removed. IVC filter placement was not associated with a reduced risk of mortality and did not prevent future PE.

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.

scholarly journals Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population

2017 ◽  
Vol 44 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Damian Everhart ◽  
Jamieson Vaccaro ◽  
Karen Worley ◽  
Teresa L. Rogstad ◽  
Mitchel Seleznick
Keyword(s):  
Managed Care ◽  
Inferior Vena Cava ◽  
Retrospective Analysis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Filter 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.

Duplication of the Inferior Vena Cava in a Patient Presenting for IVC Filter Placement

2010 ◽  
Vol 11 (2) ◽  
pp. 162-164 ◽  
Author(s):  
Danny Cheng ◽  
Steven M. Zangan
Keyword(s):  
Inferior Vena Cava ◽  
Protein C ◽  
Inferior Vena ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Clinical Implications ◽  
Factor V ◽  
Ivc Filter ◽  
Protein C Deficiency ◽  
Filter Placement

Given the complex embryogenesis of the inferior vena cava (IVC), anatomic variations are commonly encountered. Duplication of the IVC occurs in up to 2.8% of the population. Though asymptomatic, a duplicated IVC has important clinical implications when attempting caval filtration. We present the case of a 45- year-old male with factor V leiden and protein C deficiency, who required cessation of warfarin anticoagulation in preparation for cervical laminectomy. The patient had a duplicated IVC and required placement of a caval filter in each IVC.

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.

Supplemental Use of Inferior Vena Cava Filters: A Review of An Institutional Experience.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1279-1279
Author(s):  
Parminder Singh ◽  
Robert G. Lerner ◽  
Tarun Chugh ◽  
Hoang Lai ◽  
Wilbert S Aronov
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Thromboembolic Disease ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Thrombosis ◽  
Venous Thromboembolic ◽  
Post Filter

Abstract Introduction: Increasing use of inferior vena cava (IVC) filters in recent years as a preventative measure against pulmonary embolism (PE) has raised concern for usage outside of accepted guidelines. Based on the American College of Chest Physicians 2004 guidelines for the initial treatment of deep vein thrombosis (DVT) and PE, and the Eastern Association for the Surgery of Trauma 2002 guidelines for prophylaxis of PE, placement of an IVC filter is indicated in patients who either have, or are at high risk for thromboembolism, but have a contraindication for anticoagulation, a complication of anticoagulant treatment, or recurrent thromboembolism despite adequate anticoagulation. The purpose of our study is to identify patients who meet the guidelines for IVC filter placement and to compare clinical outcomes with those who did not meet the guidelines. Methods: Charts of 558 patients who received IVC filter placement were reviewed from Jan 1, 2004 to Dec 31, 2007. Patients were divided into two groups called within-guidelines or supplemental. The within-guidelines group included patients that met the criteria described above. The supplemental indication group included patients who did not have a contraindication or failure of anticoagulation. Patient characteristics and clinical outcomes between the two groups were compared and analyzed. Results: The within-guidelines group had 362 patients and the supplemental group had 196 patients. While there were more males in the within-guidelines group, age, race, length of stay, and in-hospital mortality were comparable between the two groups. Clinical follow-up in patients with a supplemental indication showed 1 (0.5%) case of post-filter PE, 2 (1%) cases of IVC thrombosis, 7 (3.6%) cases of DVT. Patients who were in the within-guidelines indication group had 4 (1.1%) cases of post-filter PE, 13 (3.6%) cases of IVC thrombosis, and 34 (9.4%) cases of DVT. All patients who developed post-filter PE had a prior DVT at the time of filter placement, and the risk of developing post-filter IVC thrombosis and PE is higher in patients with prior thromboembolic disease. Conversely, patients who did not have a VTE event before filter placement were at a significantly lower risk of developing IVC thrombosis and PE. Conclusion: Anticoagulation should be initiated at the earliest possible time in patients treated with an IVC filter to prevent subsequent venous thromboembolic disease. Our data does not support the use of IVC filter in patients who can tolerate anticoagulation and have no prior venous thromboembolic event due to the low risk of developing pulmonary embolism

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