INFERIOR VENA CAVA FILTER RETRIEVAL 23 MONTH AFTER IMPLANTATION WITH STANDARD SNARE LOOP TECHNIQUE : CASE REPORT

1. Introduction. Pulmonary embolism (PE ) and Deep vein thrombosis (DVT ) continues to be a cause of signicant morbidity and mortality which is also third 1 leading cardiovascular cause of death . If not treated properly it also leads to chronic pulmonary hypertension and cor pulmonale . Once DVT is diagnosed treatmet is required and consist of oral anticoagulation and inferior vena cava interruption via lter placement in patients with contraindication for anticoagulation treatment. In 2003 ,the U.S .Food and Drug Administration (FDA ) cleared retrievable inferior vena cave lters (rIVCFs) for clinical use , after that its uses exponentially increases . In parallel with these trends ,there has been growing awareness of device –related complication including fracture , penetration to adjuscent structure , migration , thrombosis and some time embolisation of fractured segment in heart that leads to cardiac 2 3 peforation , arrhythmia and death . In response , the FDA released safety communication in 2010 and 2014 advocating immediate retrieval of 4 lter once mechanical prophylaxis was no longer uses .However retrieval of lter remained rare with rates reported as low as 8.5 %. . Once lter remain in place for long duration, normal standard snare retrieval technique usually not work and alternative techniques like , Sling technique , 5 Excimer laser and Endobronchial forcep supported methods can be used . But prolong duration of lter implantion always associated with less chance of lter retrieval and associated with multiple complication .

Neutrophil Extracellular Traps Participate in the Development of Gastric Cancer Associated Thrombosis

Background: Development of venous thromboembolism (VTE) is associated with high mortalities among gastric cancer (GC) patients. Neutrophil extracellular traps (NETs) have been reported to correlated with prothrombotic state in some diseases. We hypothesize that NETs participate in the development of GC-associated thrombosis.Methods: The level of NETs in blood and tissue samples of patients were analyzed by ELISA, flow cytometry and immunofluorescence (IF). NETs generation and hypercoagulation of platelets and endothelial cells (ECs) in vitro were observed by IF. NETs procoagulant activity (PCA) was performed by fibrin formation and thrombin-antithrombin complex (TAT) assays. Thrombosis in vivo was measured in murine model induced by flow stenosis in the inferior vena cave (IVC).Results: NETs were likely to form in blood and tissue samples of GC patients compared with healthy individuals. In vitro studies that GC cells and their conditioned medium (CM), but not gastric mucosal epithelial cell can stimulate NETs releasing from neutrophils. In addition, NETs induced hypercoagulable state of platelets by up-regulating the expression of phosphatidylserine (PS) and P-selectin on the cells. Furhter, NETs stimulated adhesion of normal platelets on glass surfaces. Similarly, NETs triggered the conversion of ECs to hypercoagulable phenotypes by down-regulating the expression of their intercellular tight junctions but up-regulating that of tissue factor (TF). Treatment of normal platelets or ECs with NETs augmented the level of plasma fibrin formation and TAT complex. Meanwhile, in the models of IVC stenosis, tumor-bearing mice showed stronger ability to form thrombi and NETs were abundantly accumulated in the thrombi compared with control mice. Notably, combination of DNase-1, activated protein C (APC) and Sivelestat markedly abolished the PCA of NETs.Conclusions: Our findings demonstrate that GC-induced NETs strongly increase the risks of VTE development both in vitro and in vivo. NETs are potential therapeutic targets in the prevention and treatment of VTE in GC patients.

A modified wire-loop snare technique for the retrieval of inferior vena cava filter with embedded hook

Common obstacles to successful retrieval of retrievable inferior vena cave filter include embedded filter hook and severe tilt of the filter. We described a modified wire-loop snare technique using self-made fishhook-like pigtail catheter and 11-F-long sheath to retrieve a severe tilted filter with embedded hook successfully. The modified wire-loop snare technique is simple and effective requiring only standard equipment and single venous access. This technique may be suitable for some types of retrievable filter with embedded hook.