Placement of Simultaneous Inferior Vena Cava Filter During Emergent Open Pulmonary Thromboembolectomy

Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. Materials and Methods: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21–88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. Results: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2–2204 days). Follow up was 81% complete in surviving patients. Actuarial survival at one and three years was 83% for the SIM group and 43% for the SEP group, respectively. There were no differences in cardiopulmonary bypass (CPB) times and temperatures, chest tube outputs, or length of stay between groups. Using multivariable logistic regression, we found SIM was associated with increased survival (p=0.09). Further analysis showed patients >55 years in the SEP group were at significantly higher risk of death (hazard ratio [HR]=7.1:1; 95% confidence interval [CI]: 1.55, 32.5, p=0.011). Conclusion: IVC filter placement can be performed simultaneously and safely at PTE. Age >55 years and PTE with IVC filter placed separately were at significantly higher risk of death. A larger cohort is needed to evaluate efficacy of simultaneous IVC filter placement and PTE.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

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.

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

Blood ◽

10.1182/blood.v112.11.1279.1279 ◽

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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Clinical Outcomes After Inferior Vena Cava Filter (IVCF) Placement in Cancer Patients: A Retrospective Study.

Blood ◽

10.1182/blood.v114.22.1076.1076 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1076-1076

Author(s):

Anand Narayan ◽

Hyun Kim ◽

Kelvin Hong ◽

Adrea Lee ◽

Michael B. Streiff

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Cancer Patients ◽

Inferior Vena ◽

Vena Cava ◽

Johns Hopkins Hospital ◽

Similar Proportion ◽

Filter Placement ◽

The Impact

Abstract Abstract 1076 Poster Board I-98 Purpose: Cancer patients are at increased risk for recurrent venous thromboembolism (VTE) and bleeding during anticoagulation. Therefore, inferior vena cava filters (IVCF) are likely to be considered in VTE treatment in cancer patients. There are few data available to determine the safety and efficacy of IVCF in cancer patients. The purpose of this study was to compare the outcome of patients with and without cancer after IVCF placement. Materials and Methods: After institutional review board approval was obtained, consecutive patients who received an IVCF at the Johns Hopkins Hospital were identified using Current Procedural Terminology (CPT) codes. Demographic and clinical data were retrieved from the institutional electronic medical record (EMR). Clinical events including objectively-documented VTE were confirmed by an independent review of the EMR by two investigators. The outcome of patients with and without cancer was compared using compared using non-parametric and parametric statistics. Marginal structural models were used to model the impact of anticoagulation on VTE. Results: Between January 1, 2002 and December 31, 2006, 702 patients had an IVCF placed at the Johns Hopkins Hospital. 220 patients (31.3%) had cancer. The median age of the patients with and without cancer was 64 and 55 years, respectively (p < 0.001). Women constituted 47% of patients with and without cancer. 72.6% of patients with and 53.5% without cancer were Caucasian (p < 0.001). The most common cancer types were 77 gastrointestinal cancers (34.5%), 29 genitourinary cancers (13.0%) and 29 gynecologic cancers(13.0%). Metastatic disease was present in 49.5%. Mean follow up was 434 days (range 1 to 2638) for the overall study population and 262 days (1 to 2546) for cancer patients and 524 days (1 to 2638) for non cancer patients. 342 patients (48.8%) died during follow up. Cancer patients were more likely to receive filters for contraindications to anticoagulation and less likely for primary prophylaxis than non-cancer patients (p = 0.024). Cancer patients were more likely to present with pulmonary embolism (PE) (p < 0.001) and IVC thrombus (p = 0.043). Permanent IVCF were more commonly used in cancer patients (48.1% vs 34.6%, p < 0.001). For both cancer and non-cancer patients, the Optease filter was most commonly used retrievable filter (37.1%) while the Trapease filter was the most commonly used permanent filter (30.5%). Anticoagulation (AC) after IVCF placement was used in a similar proportion of cancer and non-cancer patients (42.7% vs. 37.6%, p=0.19). During follow up, 134 patients (19%) experienced VTE events (103 deep vein thrombosis [DVT], 35 pulmonary embolism [PE], 28 IVC thrombosis [IVCT]) Cancer patients were equally likely to suffer DVT (17.4% vs. 13.3%, p = 0.139) and PE (5.8% vs. 4.6%, p = 0.473) as non-cancer patients, but more likely to develop IVCT (6.2% versus 2.8%, p = 0.029). Among 103 cancer patients who were treated with AC post-IVCF, 34(33.0%) developed VTE compared with 40 of 173 non-cancer patients (23.1%) (p=0.07). Conclusions: Our retrospective cohort indicates that IVCF are commonly used to treat VTE in cancer patients. VTE was common after IVCF placement. Compared with patients without cancer, cancer patients were equally likely to suffer DVT or PE but more likely to develop IVCT post-IVCF placement. AC post-filter placement did not appear to be protective against VTE and there was a trend toward more VTE among cancer patients despite AC. These data suggest that IVCF may result in more thrombotic events in cancer patients and should be reserved for patients with acute VTE and contraindications to anticoagulation. Prospective studies are warranted to confirm these data. Disclosures: No relevant conflicts of interest to declare.

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Efficacy and safety of rivaroxaban in patients with inferior vena cava filter placement without anticoagulation contraindications (EPICT): a prospective randomised controlled trial study protocol

BMJ Open ◽

10.1136/bmjopen-2020-045530 ◽

2021 ◽

Vol 11 (10) ◽

pp. e045530

Author(s):

Libin Zhang ◽

Miaomiao Li ◽

Yuefeng Zhu ◽

Zhenyu Shi ◽

Wan Zhang ◽

...

Keyword(s):

Pulmonary Embolism ◽

Randomised Controlled Trial ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Controlled Trial ◽

Vena Cava ◽

Ivc Filter ◽

Efficacy And Safety ◽

Filter Placement ◽

Randomised Controlled

IntroductionInferior vena cava (IVC) filters are commonly used in patients with venous thromboembolism to prevent fatal pulmonary embolism, but the thrombosis risk increases after filter placement. Warfarin is a widely anticoagulant, but long-term monitoring and dose adjustments are required. Anticoagulation with rivaroxaban is more straightforward as it dose not require laboratory monitoring. This study compares the efficacy and safety of rivaroxaban and warfarin as an in anticoagulation therapy for patients with IVC filter placement.Methods and analysisThis is a multicentre, randomised controlled trial. In total, 200 patients with deep vein thrombosis (DVT) with IVC filter implantation from 10 hospitals will be recruited. The patients will be randomised to the experimental group (rivaroxaban) or the control group (nadroparin overlapped with warfarin). The primary outcomes include death of any cause, pulmonary embolism (PE)-related death, bleeding and recurrent PE/DVT. The secondary outcomes include the percentage of other vascular events, IVC filter retrieval failure and net clinical benefits. This study aims to provide reliable, verification for the efficacy and safety of rivaroxaban antithrombotic therapy after IVC filter placement.Ethics and disseminationThe study was approved by the Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (approval number: (2019) 295). The results will be disseminated through presentations at scientific conferences and publications in peer-reviewed journalsTrial registration numberNCT04066764.

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

Vascular Medicine ◽

10.1177/1358863x17726596 ◽

2017 ◽

Vol 22 (6) ◽

pp. 512-517 ◽

Cited By ~ 2

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.

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

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-017-1507-z ◽

2017 ◽

Vol 44 (2) ◽

pp. 179-189 ◽

Cited By ~ 6

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

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

The Journal of Vascular Access ◽

10.1177/112972981001100215 ◽

2010 ◽

Vol 11 (2) ◽

pp. 162-164 ◽

Cited By ~ 5

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.

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