Management of infected caval filter with simultaneous aortic pseudoaneurysm and retroperitoneal perforation: a case report and literature review

Vascular ◽  
2012 ◽  
Vol 20 (4) ◽  
pp. 225-228 ◽  
Author(s):  
M Mura Assifi ◽  
Gabor Bagameri ◽  
Paul J Dimuzio ◽  
Joshua A Eisenberg
Keyword(s):  
Inferior Vena ◽  
Intravenous Drug User ◽  
Vena Cava ◽  
Operative Management ◽  
Iliopsoas Muscle ◽  
Complication Rates ◽  
Aortic Pseudoaneurysm ◽  
Ivc Filters ◽  
Multiple Structures ◽  
Retroperitoneal Perforation

Inferior vena cava (IVC) filters have been reported to have complication rates up to 35%. Penetration of surrounding retroperitoneal structures is an uncommon, but potentially serious, complication, with several reports in the literature. We present a unique case of a 34-year-old intravenous drug user with infected IVC filter struts penetrating multiple structures simultaneously. Definitive operative management was necessary for removal of filter struts from the aorta, the second part of the duodenum and the iliopsoas muscle. Drainage and debridement of an associated iliopsoas abscess was performed, followed by aortic and caval reconstruction.

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.

Inferior Vena Cava Filter - Appropriate Use and Retrieval

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5912-5912
Author(s):  
Rena Shah ◽  
Anita Turk ◽  
Bilal Rahim ◽  
Waddah Arafat ◽  
Moniba Nazeef ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Conflicts Of Interest ◽  
Vena Cava ◽  
Complication Rates ◽  
Ivc Filter ◽  
Appropriate Use ◽  
Filter Placement ◽  
Ivc Filters ◽  
Retrievable Ivc Filters

Abstract Inferior vena cava (IVC) filters, first introduced in 1998, have been utilized to reduce risk of pulmonary embolism (PE) in the setting of an inability to anticoagulate patients. The use of IVC filters has increased and continues to rise, especially with the introduction of retrievable IVC filters. Since their initial introduction, guidelines have been developed on the appropriate use of IVC filters. According to the American College of Chest Physicians (ACCP), the use of an IVC filter is limited to patients with an absolute contraindication to therapeutic anticoagulation or failure or complication of anticoagulation in the setting an acute proximal venous thrombus. Relative indications for IVC filter placement include high clot burden in setting of low cardiopulmonary reserve, high risk patients, or severe trauma without documented thrombosis. In 2010, the FDA announced a safety communication recommending removal of retrievable IVC filters due to reports of several adverse clinical outcomes associated with retained filters including thrombus formation, recurrent PE, filter migration, erosion or perforation through the IVC wall, and filter fracture with fragment embolization. In 2014, the FDA recommended removal of the IVC filter within 2 months after filter placement if the patient's risk of thrombosis had passed. In this retrospective analysis of IVC filter management, we reviewed indications for placement according to current guidelines as set by the ACCP, initiation of appropriate anticoagulation, complication rates, and retrieval rates. In addition, we compared the data prior to the FDA recommendations in late 2014 and data after the recommendations to determine if there was a change in practice. After reviewing 179 patients, 89 patients in 2014 and 90 patients in 2015, who underwent IVC filter placement, only 81% (N=145) of patients had appropriate indications for IVC filter placement and 30% (N=54) of patients had inappropriate anticoagulation after IVC filter placement, given as prophylactic dosing of low molecular weight heparin. A comparison of retrieval rates prior to and after the FDA warning, showed a 19% (60% in 2014 vs 79% in 2015) improvement in IVC filter removals. There was an 11% complication rate, mainly related to IVC filter related acute DVT or IVC occlusion. A root cause analysis specifically for inappropriate IVC filter placement and appropriate anticoagulation and determined that familiarity of the guidelines and non-evidence based recommendations from consultants were major factors. Based on the analysis, we next plan to utilize the electronic health record system to help clinicians understand indications and when to initiate appropriate anticoagulation, with the opportunity for hematology consultants to be involved in situations that do not clearly fit within published guidelines. Disclosures No relevant conflicts of interest to declare.

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 Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

2017 ◽  
Vol 22 (6) ◽  
pp. 512-517 ◽  
Author(s):  
Jieun Kang ◽  
Heung-Kyu Ko ◽  
Ji Hoon Shin ◽  
Gi-Young Ko ◽  
Kyung-Wook Jo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Predictive Factors ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Retrieval Rate ◽  
Filter Retrieval ◽  
Ivc Filters ◽  
Filter Insertion

Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.

scholarly journals Advantages and disadvantages of femoral port systems in hematоlogical patients with superior vena cava syndrome

2020 ◽  
Vol 65 (4) ◽  
pp. 403-416
Author(s):  
G. M. Galstyan ◽  
M. V. Spirin ◽  
M. Yu. Drokov ◽  
I. E. Kostina ◽  
Ya. K. Mangasarova
Keyword(s):  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Complication Rates ◽  
Femoral Access ◽  
Advantages And Disadvantages ◽  
Vena Cava Syndrome

Background. In the superior vena cava syndrome, vein catheterisation provides an alternative for vascular access. Few reports describe the usage of femoral ports.Aim. Description of pros and contras for femoral port installation in patients with haematological malignancies and the superior vena cava syndrome.Materials and methods. This prospective non-randomised, single-centre study included 163 haematological patients implanted 72 ports in superior vena cava, 35 — in inferior vena cava and inserted with 156 non-tunnelled femoral catheters. Catheterisation properties, complications, duration of use and reasons for port and catheter removal were registered.Results. No significant differences were observed between ports in superior and inferior vena cava as per the frequency of urokinase use in catheter dysfunction, catheter dislocation, catheter-associated bloodstream and pocket infections. Differences were revealed in the catheter-associated thrombosis rate, which was higher with femoral access (17.0 % or 0.9/1000 catheter days vs. 8.3 % or 0.2/1000 catheter days, p = 0.017). Ports in inferior vena cava had a lesser duration of use than in superior vena cava (p = 0.0001). Unlike femoral ports, non-tunnelled femoral catheters had higher rates of catheter-associated thrombosis (9/1000 vs. 0.9/1000 catheter days, p = 0.002) and infection (4.9/1000 vs. 0.3/1000 catheter days, p = 0.002). One lymphoma therapy course required one femoral port or 1 to 14 (median 3) non-tunnelled femoral catheters.Conclusion. Femoral port implantation is a necessary measure in patients with the superior vena cava syndrome. It has advantages in terms of catheterisation frequency, lower infectious and thrombotic complication rates compared to non-tunnelled femoral catheters.

scholarly journals Optimal Time of Extraction Retrievable Inferior Vena Cava Filters in Venous Thromboembolic Treatment: Evidence Based Case Report

2021 ◽  
Vol 2 (1) ◽  
pp. 41-47
Author(s):  
Akhmadu Muradi ◽  
Rudi Hermansyah
Keyword(s):  
Inferior Vena Cava ◽  
Dwell Time ◽  
Inferior Vena ◽  
Vena Cava ◽  
Optimal Time ◽  
Standard Time ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Adjacent Structures ◽  
Successful Retrieval

Background: Inferior vena cava (IVC) filters have been proven to be significantly advantageous and clinically efficacious in the prevention of deathly venous thromboembolism, but also carry long-term risks, such as device failure, filter fracture, migration, penetration into adjacent structures, etc. Retrievable filters offer the same degree of protection, and subsequently lower those risk by removing them after they aren’t needed. Unfortunately, increasing use of retrievable filters leads to one alarming trend: there’s massive number of filters that are left for an extended time. Whether the time between deployment and retrieval affects filter’s technical success of retrieval remains questionable. Here is a case of a 45-year old woman who had undergone retrievable IVC filter due to pulmonary embolism risk. The patient only came to clinician for routine follow- up once, one month after deployment. One year later, the patient felt abdominal pain and asked to remove the filter. After one failed attempt, the clinician decided to leave the filter in situ as permanent filter. Method: Literature searching was conducted in several databases (ScienceDirect, EbscoHost, and ClinicalKey) using specified keywords. Six articles that had been passed exclusion and inclusion criteria, were eventually appraised and extracted. Results: Of all six articles that are included in this study, there are no standard time of retrieval. Each study provides data regarding their attempted retrieval, successful retrieval, and dwell time. Only two articles (Uberoi et al and Glocker et al) analyze the relationship between time of retrieval and successful retrieval. Uberoi et al claims filter retrieval statistically more successful if the dwell time is less than 9 weeks, whereas Glocker et al states the procedure is considerably more successful within 3-4 months (117 days) after deployment. The reasons of retrieval failure in these studies are varied, including device angulation, filter incorporation with IVC wall, and penetration to IVC wall and adjacent structures, or significant thrombus inside the filter. Conclusion: There are no standard time of retrieval, but clinicians could follow FDA recommendation by removing the filter when it isn’t necessarily needed. However, a time span of 3-4 months between implantation and retrieval can be respectable choice to make sure the maximum chance at retrieval success.

The Role for Prophylaxis Inferior Vena Cava Filters in Patients Undergoing Bariatric Surgery: Replacing Anecdote with Evidence

2012 ◽  
Vol 78 (12) ◽  
pp. 1349-1361 ◽  
Author(s):  
Ben Shamian ◽  
Ronald S. Chamberlain
Keyword(s):  
Bariatric Surgery ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Early Mobilization ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Number Of Patients ◽  
Bariatric Patients

The number of patients choosing surgical alternatives for weight reduction continues to increase. Despite common thromboembolic preventive methods, which include perioperative subcutaneous heparin injections, early mobilization, and sequential compression devices, postoperative deep vein thrombosis/pulmonary embolism remains a devastating complication after bariatric surgery. The role prophylactic inferior vena cava (IVC) filters may play in bariatric surgery remains controversial, and this article aims to address the risks and benefits of prophylactic IVC filters in high-risk bariatric patients and suggest an evidence-based algorithm for their use.

scholarly journals A rare case of arteriovenous fistula formation in a patient with inferior vena cava thrombosis, successfully managed with endovascular recanalisation

2019 ◽  
Vol 5 (4) ◽  
pp. 20190007
Author(s):  
Vanya Joshi ◽  
Frances Sheehan ◽  
Alexander Chapman
Keyword(s):  
Inferior Vena Cava ◽  
Arteriovenous Fistula ◽  
Animal Studies ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lower Extremities ◽  
Venous Hypertension ◽  
Fistula Formation ◽  
Ivc Thrombosis ◽  
Ivc Filters

Inferior vena cava (IVC) filters are recommended for patients with proximal deep vein thrombosis (DVT) who are not eligible for anticoagulation. Long-dwelling filters are well-known to be associated with the development of IVC thrombosis. Chronic caval occlusion can lead to a severe post-thrombotic syndrome (PTS), with manifestations of chronic venous insufficiency in the lower extremities. Animal studies have shown that post-thrombotic inflammation can trigger the development of an arteriovenous fistula (AVF), however, there is limited evidence for this phenomenon in patients with PTS. We describe the case of a spontaneous AVF in a patient with long-standing IVC thrombosis. It was postulated that the AVF could be compounding the venous hypertension and severe swelling of his lower extremities. The case additionally demonstrates the successful results of endovascular recanalisation for an occluded filter in the presence of an AVF.

scholarly journals Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Saba S. Shaikh ◽  
Suneel D. Kamath ◽  
Debashis Ghosh ◽  
Robert J. Lewandowski ◽  
Brandon J. McMahon
Keyword(s):  
Inferior Vena Cava ◽  
Cancer Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Absolute Contraindication ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Recurrent Vte ◽  
Clinically Significant

Background. The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives. Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/Methods. A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results. 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions. The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.

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