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

Blood ◽  
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.

Permanent IVC filter strut penetration into an abdominal aortic aneurysm

2021 ◽  
Vol 14 (6) ◽  
pp. e241962
Author(s):  
Juehea Lee ◽  
Graham Roche-Nagle
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
Ct Angiogram ◽  
Abdominal Aortic ◽  
History Of ◽  
Deep Vein

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.

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

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.

scholarly journals Chronic Inferior Vena Cava Filter Thrombosis: Endovascular Treatment and One-Year Follow-Up with Intravascular Ultrasonography

2020 ◽  
Vol 47 (2) ◽  
pp. 140-143
Author(s):  
Andrés Mesa ◽  
Eliana Milazzo ◽  
Oscar Rivera ◽  
Tabata Hernández ◽  
Gilberto Umanzor
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Neointimal Hyperplasia ◽  
Vena Cava ◽  
Ivc Filter ◽  
Intravascular Ultrasonography ◽  
Filter Placement ◽  
Vein Thrombosis ◽  
History Of ◽  
One Year

Inferior vena cava (IVC) filter thrombosis can be fatal when it is not detected and treated. Its management can be challenging, because little evidence supports specific treatments. We present the case of a 72-year-old man with a history of deep vein thrombosis in whom IVC filter thrombosis developed 7 years after filter placement. Recanalization with oral anticoagulation had failed. Using intravascular ultrasonography, we performed pharmacomechanical thrombolysis, deploying 2 stents simultaneously through the IVC filter and then 2 more into the iliac veins, with excellent results. One year later, the patient's veins and IVC filter were patent, his symptoms were greatly improved, and only nonobstructive neointimal hyperplasia was seen. This case highlights the usefulness of balloon venoplasty and double-barrel stent placement in restoring blood flow through an occluded IVC, and the value of intravascular ultrasonography during and after such procedures.

scholarly journals Inferior Vena Cava Filter in Childhood Septic Deep Vein Thrombosis

2020 ◽  
Author(s):  
Salim Aljabari ◽  
Shahzad Waheed ◽  
Ryan Davis ◽  
Amruta Padhye
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena Cava Filter ◽  
Pediatric Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Safety And Efficacy ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Deep Vein

AbstractInferior vena cava (IVC) filter in venous thromboembolism (VTE) is an alternative to anticoagulation when the latter is contraindicated. The use of IVC filter in pediatrics continues to be rare and has not increased despite the ever-increasing rates of childhood VTE. Historically, septic VTE was regarded as a contraindication to IVC filter. Safety and efficacy of IVC filters in septic VTE have been reported in adult patients but not in pediatric patients. In this study, we reported a safe use of IVC filter in a critically ill 12-year-old patient with a large IVC thrombus and multiple pulmonary embolisms with favorable outcome.

Femoral Retrieval of Conical Filters

2018 ◽  
Author(s):  
Mikin V. Patel ◽  
Steven Zangan
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Effective Treatment Option ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Deep Vein ◽  
Filter Migration

Inferior vena cava (IVC) filters are a safe, effective treatment option for the prevention of pulmonary embolism in patients who either have contraindication to or fail anticoagulation. However, filters pose long-term risks, such as IVC thrombosis, deep vein thrombosis, penetration of the IVC wall, filter fracture, and filter migration. IVC filters should be retrieved once the indication for placement has passed. However, cervical access frequently becomes compromised. This chapter reviews strategies for retrieving IVC filters from a femoral approach. Various techniques are discussed, including snaring the filter struts and the use of bilateral femoral sheaths to recapture the IVC filter.

scholarly journals Controversies in the management of venous thromboembolism

2019 ◽  
Vol 2 (1) ◽  
pp. 48-52
Author(s):  
James P. Lamberti
Keyword(s):  
Venous Thromboembolism ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Recent Literature ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Outpatient Settings ◽  
Deep Vein ◽  
Acute Pe

Background: Venous thromboembolism (VTE) includes pulmonary embolism (PE) and deep vein thrombosis (DVT), and is frequently encountered in both inpatient and outpatient settings. Methods: This review examines three significant controversies in the management of VTE. Results: Thrombolytic therapy has been available for >50 years, yet its role in the management of acute PE remains controversial. The role of interruption of the venous system by insertion of an inferior vena cava filter into a VTE is a therapeutic challenge for hospital-based physicians. The duration of anticoagulation as therapy for VTE is a challenge for many outpatient physicians. Conclusion: Review of recent literature will guide clinicians in the management of venous thromboembolism.

Sclerotherapy is a safe method of treatment of chronic venous disorders in older patients: A prospective and comparative study of consecutive patients

2016 ◽  
Vol 32 (4) ◽  
pp. 234-240 ◽  
Author(s):  
Jean-Luc Gillet ◽  
Claudine H Desnos ◽  
Michel Lausecker ◽  
Christian Daniel ◽  
Jean-Jerome Guex ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Comparative Study ◽  
Older Patients ◽  
Medial Gastrocnemius ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Objectives An aging population requires evaluation of methods of treatment for older patients. Our objective was to evaluate the indications, practical modalities, safety and tolerability of sclerotherapy in patients 75 years of age and older (group 1) and compare with a control group of patients 18 to74 years of age (group 2). Method This observational, multicentre, prospective and comparative study was conducted by the French Society of Phlebology. Each centre collected in 10 to 20 patients ≥75 years of age and an equal number of patients <75 years of age treated by sclerotherapy, the treatment indication, the patient's personal history, the CEAP clinical class, the type of the veins being treated, the characteristics of sclerotherapy and the complications (immediately after treatment and at one-month follow-up). Results Population: In total, 418 patients were enrolled in 15 centres: 176 patients in group 1 (mean: 79.4 years) and 242 patients in group 2 (mean: 52.7 years).CEAP clinical classes C4, C5 and C6, history of deep vein thrombosis (12.5%) and superficial vein thrombosis (11.9%), long-term anticoagulant therapy (9.1%) and antiplatelet therapy (16.5%) were more frequent in older patients.All types of veins were treated from saphenous veins to telangiectasias. Sclerotherapy features: There was no difference in concentration of the sclerosing agents. When foam sclerotherapy was used (84% of patients), the injected volume was lower in group 1. Complications: One vasovagal syncope occurred in group 1. One asymptomatic distal deep vein thrombosis, confined to the Medial Gastrocnemius Veins, was reported in both groups at one-month follow-up. Conclusions This study shows the feasibility and safety of sclerotherapy in older patients, with no specific complications nor need for special precautions.

scholarly journals May–Thurner Syndrome: A Consideration for Deep Vein Thrombosis in Males

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tay Tian En Jason ◽  
Tay Jia Sheng ◽  
Tieng Chek Edward Choke ◽  
Pooja Sachdeva
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Vena Cava ◽  
Postthrombotic Syndrome ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
Left Lower Limb ◽  
Deep Vein

May–Thurner syndrome (MTS) is an underdiagnosed cause of lower limb deep vein thrombosis (DVT). The clinical prevalence of MTS-related DVT is likely underestimated, particularly in patients with other more recognisable risk factors. MTS is classically described in females between the age group of 20–50 years. In patients with acute iliofemoral thrombosis, medical treatment with anticoagulation alone has been associated with higher risk of postthrombotic syndrome (PTS) and lower iliofemoral patency rates, as compared to endovascular correction. We describe a case of MTS-related extensive iliofemoral DVT occurring in a middle age male who presented with acute onset of left lower limb swelling and pain, complicated by pulmonary embolism. Doppler compression ultrasonography of the left lower limb showed partial DVT extending from the left external iliac to the popliteal veins, and contrasted computed tomography (CT) of the thorax abdomen and pelvis established features of MTS, together with right pulmonary embolism. He was started on low molecular weight heparin (LMWH) and then underwent left lower limb AngioJet pharmacomechanical thrombolysis/thrombectomy, iliac vein stenting, and temporary inferior vena cava (IVC) filter insertion. After the procedure, the patient recovered and improved symptomatically with rapid resolution of this left lower limb swelling and pain. He was switched to an oral Factor Xa inhibitor and was subsequently discharged. After 1-month follow-up, he remained well with stent patency visualised on repeat ultrasound and underwent an uneventful elective IVC filter retrieval with subsequent plans for a 1-year follow-up.

scholarly journals Self-centering of the Cook Celect inferior vena cava filter

2021 ◽  
Vol 5 ◽  
pp. 5
Author(s):  
Matthew Nathaniel Williams ◽  
Daniel Howard Golwyn ◽  
Kevin Webster Dickey ◽  
John David Regan
Keyword(s):  
Computed Tomography ◽  
Total Knee Arthroplasty ◽  
Inferior Vena Cava ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
History Of ◽  
Total Knee

A patient who underwent placement of an inferior vena cava (IVC) filter before total knee arthroplasty with a history of venous thromboembolism following knee replacement 10 years prior. Difficulty releasing the filter during delivery resulted in approximately 17° of medial tilt of the filter apex. Follow-up computed tomography after arthroplasty 4 months after placement demonstrated that the filter self-centered in the IVC with subsequent straightforward retrieval.

Inflammatory Monocyte Counts Determine Venous Blood Clot Formation and Resolution

2021 ◽  
Author(s):  
Fatemeh Shahneh ◽  
Hans Christian Probst ◽  
Sabine C. Wiesmann ◽  
Noelia A-Gonzalez ◽  
Wolfram Ruf ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Tissue Factor ◽  
Inferior Vena ◽  
Thrombus Formation ◽  
Vena Cava ◽  
Wild Type ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Monocytes are thought to be involved in venous thrombosis but the role of individual monocyte subpopulations on thrombus formation, clot inflammation, and degradation is an important unresolved issue. We investigate the role of inflammatory Ly6C hi monocytes in deep vein thrombosis and their potential therapeutic impact. Methods: Frequencies and compositions of blood monocytes were analyzed by flow cytometry in CCR2 −/− (C-C chemokine receptor type 2) and wild-type mice of different ages and after treatment with the NR4A1 (nuclear receptor group 4 family A member 1, Nur77) agonist CnsB (cytosporone B). TF (tissue factor) sufficient and deficient Ly6C hi monocytes were adoptively transferred into aged CCR2 − /− mice. Thrombus formation and size were followed by ultrasound over a 3-week period after surgical reduction of blood flow (stenosis) in the inferior vena cava. Results: Reduced numbers of peripheral monocytes in aged (>30 w) CCR2 −/− mice are accompanied by reduced thrombus formation after inferior vena cava ligation. Reducing the number of inflammatory Ly6C hi monocytes in wild-type mice by CsnB treatment before ligation, similarly suspends clotting, while later treatment (d1 or d4) reduces thrombus growth and accelerates resolution. We describe how changes in inflammatory monocyte numbers affect the gradual differentiation of monocytes in thrombi and show that only tissue factor-competent Ly6C hi monocytes restore thrombosis in aged CCR2 − /− mice. Conclusions: We conclude that the number of inflammatory Ly6C hi monocytes controls deep vein thrombosis formation, growth, and resolution and can be therapeutically manipulated with a NR4A1 agonist at all disease stages.

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