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Severe tilt with embedded hooks is a common obstacle to successful inferior vena cava (IVC) filter retrieval. We present a case for which the biopsy forceps-assisted loop snare technique was successfully used to retrieve filters with hooks embedded in the IVC wall for which conventional retrieval failed. The technique is effective and provides a less-invasive, low-cost method for the complex retrieval of IVC filters. Introduction: Severe tilt with embedded hooks is a common obstacle to successful inferior vena cava (IVC) filter retrieval. Methods: Disposal biopsy forceps were used to remodel the filter hook in the center position to release the embedded hook from the caval wall. Results: The biopsy forceps-assisted loop snare technique was successfully used to retrieve filters with hooks embedded in the IVC wall. Conclusion: The biopsy forceps-assisted loop snare technique we present here offers a new solution for the complex retrieval of IVC filters. This technique may prove useful in cases where standard techniques at filter retrieval fail.

Background/Objective Deep vein thrombosis and pulmonary embolism have been described as complications in previously diagnosed COVID-19 patients, especially in those admitted in critical ill units, but, to our knowledge, there is no report of venous thromboembolism in an otherwise asymptomatic COVID-19 patient. Methods We report the case of a 22-year-old female, healthy patient with pulmonary embolism (Pulmonary Embolism Severity Index Score 22 points, low risk) and extensive proximal deep vein thrombosis as a unique clinical manifestation of the new coronavirus disease. Results The patient had no risk factors and no familial history of venous thromboembolism. All thrombophilia markers were negative. The patient was treated as first by an independent vascular team, performing vena cava filter placement and open thrombectomy. Her symptoms worsened, and after 3 weeks, she underwent US-enhanced thrombolysis and mechanical thrombectomy. She was isolated for 10 days and did not develop any other clinical manifestation of COVID-19 disease. During follow-up, she remained asymptomatic and complete patency of the venous system was achieved. Full oral anticoagulation was conducted for 6 months. Conclusion COVID-19 appears to be a multi-symptomatic disease, and venous thromboembolism without any other previous described COVID-19 symptom could be considered one of its diverse clinical presentations and RT-PCR for SARS-CoV-2 tests emerge to be mandatory in patients with otherwise unexpected venous thrombosis.

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.

Objective The Simon Nitinol filter is a bi-level filtration device designed for permanent implantation that is no longer commercially available, but may result in similar complications to current commercially available long term indwelling temporary or permanent filters. Complications related to indwelling inferior vena cava filters include inferior vena cava thrombosis, inferior vena cava penetration, filter migration, and filter fracture. There is a paucity of reports describing the technical aspects related to retrieval of Simon Nitinol filters. Materials and methods This study consisted of five patients with Simon Nitinol filters and describes the indication for retrieval, the retrieval techniques used to remove the filters, technical success, complications, and clinical course. Results The indications for retrieval included: abdominal pain ( n = 2; 40%), iliocaval thrombosis ( n = 1; 20%), identification of an intracardiac filter fragment ( n = 1; 20%), and recurrent venous thromboembolic events ( n = 1; 20%). Retrieval techniques included: biopsy forceps ( n = 3; 60%), excimer laser extraction sheaths ( n = 3; 60%), hangman modified loop snares ( n = 3; 60%), rigid endobronchial forceps ( n = 2; 40%), and balloon deflection ( n = 2; 40%). All filters were successfully retrieved. One patient developed a post-procedural intramuscular hematoma near the site of right internal jugular sheath placement. Conclusions Simon Nitinol filters may be retrieved safely and effectively using advanced inferior vena cava filter retrieval techniques.

Purpose The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. Methods We performed a retrospective analysis of database of a tertiary hospital in 2016–2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. Results 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients’ anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. Conclusions Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.

Objectives To investigate the incidence and clinical significance of caval pseudoaneurysm and extravasation post-complex inferior vena cava filter retrieval. Methods A total of 83 patients (70% female, average age 56) underwent complex inferior vena cava filter retrieval between January 2015 and December 2019 utilizing either rigid endobronchial forceps ( n = 69, 83%) and/or excimer laser ( n = 20, 24%). Procedural variables were recorded. The incidence and size of caval pseudoaneurysms and extravasation along with treatment type and clinical outcomes were analyzed. Results Technical success in all cases was 96% (n = 80). Average fluoroscopy time was 23 min (median: 20.2, range: 0.9–129.5). Average filter dwell time was 85 months (range: 2–316 months). Caval pseudoaneurysm was detected on post-retrieval venography in 10 patients (12%) and frank extravasation occurred in 1 case (1%). Average pseudoaneurysm length and width was 20.4 mm (range: 5–45 mm) and 12.9 mm (range: 4–24 mm), respectively. Pseudoaneurysms occurred most frequently during the removal of Optease ( n = 5) and Celect ( n = 2) filters. The pseudoaneurysms completely resolved with prolonged (>5 min) balloon angioplasty in all but one instance where a small portion of the pseudoaneurysm persisted. This patient was admitted and observed overnight before being discharged without complication. The solitary case of significant extravasation was effectively managed with immediate stent placement and the patient remained hemodynamically stable. Conclusions Radiographically detectable caval pseudoaneurysm and extravasation is not uncommon in complex inferior vena cava filter retrieval and, despite being considered a major complication by Society of Interventional Radiology guidelines, can often be managed without stenting or other invasive treatment.

Objectives To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. Method Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. Results A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%–90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12–25 months of follow-up, iliac vein stents and lower extremity veins maintained patent. Conclusions The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.

Purpose To determine practice patterns of inferior vena cava filters (IVCFs), retrieval rates, and reasons why retrievable-IVCFs (R-IVCFs) are kept permanent. Methods A total of 399 patients who received IVCFs at Third Hospital of Hebei Medical University from January 2017 to December 2017 were registered and retrospectively studied. Date of demographics, baseline medical history, dwell time, reasons why R-IVCFs were kept permanent, and R-IVCFs thrombus were collected. Results A total of 399 IVCFs were placed during the study period including 27 permanent IVCFs and 372 R-IVCFs. Among all patients who received R-IVCFs, the mean dwell time was 18.25 ± 16.60 days, follow-up rate was 96.24% (358/372), and 337 R-IVCFs were attempted to be removed. Except one, 336 R-IVCFs were retrieved successfully (336/372, 90.32%). Sixty-four R-IVCFs thrombi were found during retrieval including 53 small-size thrombi (< 1 cm × 1 cm) and 13 large-size thrombi (>1 cm × 1 cm). Fifty-three R-IVCFs with small-size thrombi were removed successfully with no additional treatments. Twelve large-size thrombi were retrieved successfully after catheter-directed thrombolysis. Conclusions With good follow-up, the retrieval rate could be improved to 90.32%. The main reasons why R-IVCFs were kept permanent were to avoid losing follow-up and overcome inappropriate selections of indications or IVCF types. And R-IVCFs with thrombus could be removed safely.

Background: Indications for inferior vena cava filter (IVCF) placement are controversial. This study assesses the proportion of different indications for IVCF placement and the associated 30-day event rates and predictors for all-cause mortality, deep vein thrombosis (DVT), pulmonary embolism, and bleeding after IVCF placement. Method: In this 5-year retrospective cohort observational study in a quaternary care center, consecutive patients with IVCF placement were identified through cross-matching of 3 database sets and classified into 3 indication groups defined as “standard” in patients with venous thromboembolism (VTE) and contraindication to anticoagulants, “extended” in patients with VTE but no contraindication to anticoagulants, and “prophylactic” in patients without VTE. Results: We identified 1248 IVCF placements, that is, 238 (19.1%) IVCF placements for standard indications, 583 (46.7%) IVCF placements for extended indications, and 427 (34.2%) IVCF placements for prophylactic indications. Deep vein thrombosis rates [95% confidence interval] were higher in the extended (8.06% [5.98-10.58]) and prophylactic (7.73% [5.38-10.68]) groups than in the standard group (3.36% [1.46-6.52]). Mortality rates were higher in the standard group (12.18% [8.31-17.03]) than in the extended group (7.55% [5.54-9.99]) and the prophylactic (5.85% [3.82-8.52]) group. Bleeding rates were higher in the standard group (4.62% [2.33-8.12]) than in the prophylactic group (2.11% [0.97-3.96]). Best predictors for VTE were acute medical conditions; best predictors for mortality were age, acute medical conditions, cancer, and Medicare health insurance. Conclusions: Prophylactic and extended indications account for the majority of IVCF placements. The standard indication is associated with the lowest VTE rate that may be explained by the competing risk of mortality higher in this group and related to the underlying medical conditions and bleeding risk. In the prophylactic group (no VTE at baseline), the exceedingly high DVT rate may be related to the IVCF placement.

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.

Purpose: To evaluate the safety and efficacy of retrieval of inferior vena cava filters (IVCF) temporarily placed in a suprarenal position. Methods: Retrieval of IVCF placed in a suprarenal position was performed in 13 patients (5 men and 8 women; mean age: 45.1 ± 13.8 years) between July 2006 and May 2018 using either a loop snare technique or endobronchial forceps. Electronic medical records were reviewed for patient demographics and procedural information. Results: Inferior vena cava filters retrieved included Option Elite (n = 9, 69%) and Günther Tulip (n = 4, 31%). Caval thrombosis was not detected in any patients on pre- or postretrieval cavogram. Eleven suprarenal IVCF (84%) were retrieved during the first retrieval attempt after a median indwelling time of 1.8 months (range, 0.03-12.10 months). Retrieval was initially unsuccessful in 2 (16%) patients with Option Elite filters, but both were successfully removed on second attempt using endobronchial forceps. Thirteen suprarenal IVCF (100%) were ultimately retrieved. Conclusion: Endovascular retrieval of IVCF temporarily placed in a suprarenal position is safe and efficacious.

Inferior vena cava filter has been increasingly applied in clinical practice to prevent pulmonary embolism. Nowadays, various complications after implanting conventional filters seriously hinder clinical applications. Therefore, in this paper, a novel biodegradable inferior vena cava filter was designed based on biodegradable materials, which is an hourglass-like filter anchored inside a stent structure fixed by connecting fibers. Firstly, mechanical tests in crimp were performed to study the expansion properties of the filter, showing that the biodegradable inferior vena cava filter could achieve self-expansion easily. Furthermore, the biodegradable inferior vena cava filters and fibers were incubated in phosphate buffer media (pH = 7.4 ± 0.2) at 37°C for six months. Scanning electron microscope micrograph showed that the stents exhibited no significant dimensional and structural changes and had enough radial force to support the vessel. During the degradation period, the results of scanning electron microscope, gel permeation chromatography, differential scanning calorimetry and tensile strength analysis confirmed that the degradation rate of the hourglass-like filter was faster than the connecting fibers, achieving progressive degradation and thus avoiding the polymer fragments from blocking vessel. Cytotoxicity and hemolysis assay demonstrated good biocompatibility of the filter. For 5 mm × 10 mm sized thrombus, in vitro simulated thrombus capture test showed that the mean trapping efficiency of the filter was 90%, which was comparable to traditional inferior vena cava filter. In conclusion, all results exhibited that the as-designed biodegradable inferior vena cava filter has a potential in clinical application for patients who are at temporary high risk of venous thromboembolism.

Objective: Research is needed to guide the timing and safety of rehabilitation (physical and occupational therapy) in patients with acute deep venous thrombosis (DVT) that is untreated due to contraindications. Case Description: A 21-year-old man with Hodgkin lymphoma was admitted to the hospital for neutropenic fever. He developed gastrointestinal bleeding, diffuse alveolar hemorrhage, and bilateral lower-extremity DVT. He was not a candidate for chemical anticoagulation or placement of an inferior vena cava filter owing to thrombocytopenia. Rehabilitation was initially deferred because of concern that the thrombus could travel to the lungs, causing a pulmonary embolism. Rehabilitation was, however, started 4 days after the initial diagnosis of lower-extremity DVT to assess functional mobility and activities of daily living skills to prepare for discharge from the hospital. Results: The patient experienced no bleeding events during rehabilitation, and his acute, untreated DVT did not propagate based on clinical assessment. His Activity Measure for Post-Acute Care (AM-PAC) “6 Clicks” Basic Mobility score improved from 30.25 to 35.55 over the period of 11 days while he received rehabilitation. Conclusion: Despite having an acute bilateral lower-extremity DVT that was untreatable owing to thrombocytopenia, the patient successfully participated in rehabilitation and improved his physical functional status without an adverse event. Untreated acute venous thromboembolism in the setting of recent history of major bleeding raise concerns about physical activity restrictions. It is critical to consider both the risks and benefits of mobilizing patients and prescribing exercises in patients with these conditions.

Objective: Over the last 2 decades, there has been an exponential rise in placement of retrievable inferior vena cava (IVC) filters, while the retrieval rate has remained steadily low. Approaches to increasing filter retrieval rates have been extensively studied. Conclusion: This review presents an up-to-date review of reported data-driven variables that affect retrieval rates of IVC filters, with a focus on clinical, technical, and process factors.

Purpose: Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval. Methods: A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database. Risk factors for nonretrieval were identified using a multivariate logistic regression model. Results: Of 615 IVCFs placed, 256 were retrievable filters placed for prophylactic indications and comprised the study cohort. The most common indications were a history of venous thromboembolic disease (43.7%), malignancy (35.1%), bleeding risk precluding anticoagulation (33.9%), and trauma (22.6%). One hundred sixty-three (63.6%) were placed preoperatively. Placement was performed in 70.3% by interventional radiology, 21.4% by vascular surgery, and 8.2% by cardiology. The most common requesting services were orthopedics (67%), general surgery (11%), neurosurgery (9%), and bariatric surgery (7%). Of all, 67.6% were placed in the inpatient setting and 32.4% in outpatients. Seventy-one (27.7%) of the 256 prophylactic filters were retrieved, with a mean indwelling time of 92 ± 74 days. Inpatients were significantly less likely to have their IVCF removed (32.4% vs 57.8%; P < .001), as were preoperative patients. Conclusions: This study helps define current practice trends for the placement of prophylactic IVCFs. Importantly, the specific retrieval rate for prophylactic filters is low. This suggests that prophylactic IVCF usage is suboptimal and efforts should be taken to increase retrieval, especially among inpatients and perioperative patients.

Objectives Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments. Method The reference list of Malgor’s review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Results Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative. Conclusion Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.

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.

Catheter-directed thrombolysis (CDT) is being increasingly used for the treatment of proximal lower extremity (LE) deep venous thrombosis (DVT). However, sex differences in utilization and safety outcomes of CDT in these patients are unknown. The Nationwide Inpatient Sample (NIS) database was used to identify all patients with a principal discharge diagnosis of proximal LE or caval DVT who underwent CDT between January 2005 and December 2011 in the United States. We evaluated the comparative safety outcomes of CDT among a propensity-matched group of 1731 men versus 1731 women. Among 108,243 patients with proximal LE or caval DVT, 4826 patients (4.5%) underwent CDT. Overall, women underwent CDT less often compared to men (4.1% vs 4.9%, p

Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe/life-threatening or moderate bleeds within 72 hours of initiation of the procedure. Of the 15 patients with major bleeding, four (26.6%) developed access site-related bleeding. Multiple venous access attempts were more frequent in the major bleeding group (27.6% vs 3.6%; p

Objective To evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery. Methods Clinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups. Results An IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups. Conclusions Retrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a

Objectives To perform a meta-analysis of randomized controlled trials assessing the effectiveness of inferior vena cava filters in patients with deep vein thrombosis for preventing pulmonary embolism. Method Relevant randomized controlled trials of inferior vena cava filters for the prevention of pulmonary embolism were identified by searching electronic databases updated in February 2016. Relative risks of recurrent pulmonary embolism, recurrent deep vein thrombosis, and mortality at three months were analyzed. Results Three published randomized controlled trials were included involving a total of 863 deep vein thrombosis patients. No significant differences were detected with inferior vena cava filters placement with regard to the incidence of recurrent pulmonary embolism or fatal pulmonary embolism. There were also no significant differences in the incidence of recurrent deep vein thrombosis or mortality with inferior vena cava filters placement at three months. Conclusions Inferior vena cava filter in addition to anticoagulation was not associated with a reduction in the incidence of recurrent pulmonary embolism as compared with anticoagulation alone in patients with deep vein thrombosis in the short term.

Published reports indicate low retrieval rates for retrievable inferior vena cava (IVC) filters. We performed a historic-controlled study of a 5-year intervention (March 2007 to February 2012) to improve IVC filter retrieval rates at a university medical center serving a rural area. All adults with a retrievable filter placed were included, except those with a life expectancy

Objective To investigate nonpermanent inferior vena cava (IVC) filter in the prevention of perioperative pulmonary embolism (PE) in patients of lower extremity and/or pelvic bone fracture with deep vein thrombosis (DVT). Methods Lower extremity or pelvic bone fracture patients with lower extremity DVT hospitalized in our hospital from January 2003 to October 2014 were retrospectively analyzed. Data was analyzed for age, gender, position of fracture, position of proximal of thrombosis, indications of placement, complications, retrieval rate, and rate of entrapped filter clot. Patients who underwent IVC filter placement were selected as the filter group. The patients who did not perform IVC filter placement after 2008 and the cases between January 2003 and December 2007 were selected as control group 1 and control group 2, respectively. The incidence of perioperative symptomatic PE and mortality were analyzed. Results A total of 2763 cases complicated with DVT underwent orthopedic surgery between January 2003 and October 2014. 823 nonpermanent filters were inserted. All filters were successfully deployed with no major complications. After a mean 14.2 days indwelling time, all of temporary filters were removed. Retrieval was attempted in 556 patients with retrievable filters and was successful in 545 (98%); mean indwelling time was 16.3 days. The total retrieval rate was 90%. The incidence of PE in the filter group was significantly lower compared with the two control groups. Among the patients who received chemical anticoagulant therapy, the incidence of PE in filter group, control group 1 and control group 2 were 0.14%, 1.60% and 2.10%, respectively. The incidence of PE in filter group was also significant lower compared with control groups. Conclusion Nonpermanent IVC filter placement seems like to be a safe and effective method for preventing perioperative symptomatic and fatal PE in bone fracture patients with DVT in the present retrospective study.

Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified. Demographics, clinical data, procedures, and outcomes were extracted. Patients were followed to the last clinic visit or until they died. Results One-hundred eighty filters were placed by our group practice during the study period. Of those, a total of 10 patients were identified. Overall, there were 7 males; the mean age was 57.1 years (25–78 years). The median time between inferior vena cava filter placement and filter occlusion was 105 days (range 5–4745 days). All patients were clinically symptomatic at the time of their presentation. Nine out of 10 patients were successfully managed endovascularly. Trellis™-8 thrombectomy was the most common endovascular strategy performed ( n = 9). Four patients had balloon angioplasty, two of those with stent placement for chronically occluded inferior vena cava/iliac veins. No thromboembolic complications developed during a median follow-up period of 233 days (range 4–1083 days). Conclusions Endovascular management of inferior vena cava occlusion is feasible, safe, and effective in decreasing thrombus burden in the presence of an inferior vena cava filter. Further studies evaluating long-term inferior vena cava patency and optimal surveillance regimen after endovascular management of filter-related inferior vena cava occlusion are warranted.

Superior vena cava obstruction (SVCO) and associated thrombus formation can occur in patients with upper mediastinal or right apical masses. While stenting is useful in relieving obstruction, it can facilitate the passage of upper extremity deep vein thrombus to the pulmonary arterial tree, resulting in a potentially fatal pulmonary embolism (PE). We present a case that illustrates a novel technique, which protects the patient from PE while also relieving the SVCO. This involves placing an inferior vena cava filter in an inverted position within a superior vena cava (SVC) stent to capture emboli. This procedure offers a potentially lifesaving endovascular therapeutic option to patients who would otherwise be deemed unsuitable for SVC stenting.

Abstract 4249 Background: Despite the paucity of randomized controlled trials and strong observational studies supporting the efficacy of inferior vena cava filters (IVCFs) in venous thromboembolism (VTE) prevention, indications for placement of IVCFs have increased. Further, evidence-based guidelines for removal of retrievable filters do not exist. The purpose of this study was to characterize contemporary IVCF practices in the prevention and management of VTE, and clarify the stakeholders in IVCF placement and retrieval among trauma centers across the United States. Methods: In September 2011 a web-based survey was distributed to 1206 members of the Eastern Association for the Surgery of Trauma (EAST) in 3 waves over 3 weeks. This 31-question multiple choice and open-ended survey addressed: 1) provider and practice characteristics, 2) trauma patient population, 3) clinical practice of IVCF placement and retrieval, and 4) pharmacologic prophylaxis (PP). Results: Of the 1059 eligible providers that care for trauma patients on a routine basis, 281 completed the survey (27% response rate); 27% were identified as trauma directors. Seventy-two percent of all responents practiced in an academic setting and 74.7% in a level-1 trauma center. Sixty percent of trauma directors reported more than 1,000 trauma admissions per year. Familiarity with the 2002 EAST and 2008 American College of Chest Physicians guidelines for IVCF placement was noted by 84.3% and 63.0% of respondents, respectively. The majority of trauma centers placed IVCFs (98.9%), of which 3.6% placed only permanent IVCFs, 27.3% only retrievable IVCFs, and 67.3% both. Only 28.4% of centers had an institutional clinical protocol for IVCF placement and 25.5% for removal of IVCFs. The most common indication for IVCF placement was acute VTE and contraindication to therapeutic anticoagulation (32.4%). Prophylactic IVCFs (pIVCFs) in high-risk patients without known VTE were utilized by 97.6% of respondents. Indications for pIVCFs included inability to receive PP (26.5%), incomplete spinal cord injury (19.8%), and complex pelvic fracture with long bone fracture (19.6%). Filter insertion was performed by interventional radiologists (48.1%), vascular surgeons (35.6%), and/or trauma surgeons (15.5%) at each institution. Ultrasound guidance was used in 23.3% of IVCFs placed and 14.0% of insertions occured at the bedside. Acute and long-term complications encountered by providers included filter migration (21.0%), recurrent VTE (15.5%), hematoma (15.5%), and inferior vena cava thrombosis (13.8%). Surveillance for lower extremity deep vein thromboses in trauma patients was performed by 52% of centers. A registry to track patients with IVCFs was maintained by 38% of centers. Decisions to refer patients for IVCF removal were made by the proceduralist service (37.7%), ordering service (38.7%), and/or service following patients after discharge (12.7%). Only 2.5% of respondents removed IVCFs prior to hospital discharge. Screening for VTE prior to IVCF removal was performed with ultrasound (28%), venogram (14.4%), or computed tomography (2.5%), however 43.3% were uncertain of the screening method. In addition to IVCFs, adjunctive VTE prophylaxis indicated by respondents were sequential compression devices (26.7%), low molecular weight heparin (39.0%), unfractionated heparin (25.2%), fondaparinux (5.4%), or aspirin (2.0%). Only 1% of respondents indicated not using PP in trauma patients with IVCFs. Formal institutional PP guidelines existed in 92.9% of institutions. The most common reasons for contraindication to PP included pelvic or retroperitoneal hematoma requiring transfusion of blood products (20.0%), traumatic brain injury (18.3%), ocular injury with hemorrhage (16.3%), coagulopathy (13.6%), and solid intra-abdominal organ injury (11.4%). Sixty-one providers (7.1%) did not indicate any absolute contraindications for PP outside of acute phase of the above injuries. Conclusion: This study confirms the widespread use of IVCFs for both acute VTE and prophylactic indications. However, considerable variation in practice patterns with regards to institutional protocols for IVCF placement and retireval as well as utilization of adjunctive pharmacologic prophylaxis exists. These differences highlight the need for well-designed randomized controlled trials to address the efficacy and safety of IVCFs in trauma patients. Disclosures: No relevant conflicts of interest to declare.

Objective Dynamic changes in anatomic geometry of the inferior vena cava from changes in intravascular volume may cause passive stresses on inferior vena cava filters. In this study, we aim to quantify variability in inferior vena cava dimensions and anatomic orientation to determine how intravascular volume changes may impact complications of inferior vena cava filter placement, such as migration, tilting, perforation, and thrombosis. Methods Retrospective computed tomography measurements of major axis, minor axis, and horizontal diameters of the inferior vena cava at 1 and 5 cm below the lowest renal vein in 58 adult trauma patients in pre-resuscitative (hypovolemic) and post-resuscitative (euvolemic) states were assessed in a blinded fashion by two independent readers. Inferior vena cava perimeter, area, and volume were calculated and correlated with caval orientation. Results Mean volumes of the inferior vena cava segment on pre- and post-resuscitation scans were 9.0 cm3 and 11.0 cm3, respectively, with mean percentage increase of 48.6% ( P Conclusions There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.

Objective To evaluate retrievable IVC filters in our institution and assess their retrieval following a well-structured follow up program. Design Retrospective cohort study. Materials The medical records of patients implanted with retrievable IVC filters were reviewed. Methods All retrievable filter insertions between July 2007 and August 2011 at our institution were reviewed. Data was analyzed for age, gender, indication, complications, retrieval rate, and brand of filter inserted. Statistical analysis was done using SPSS software v19. Chi-square was used to compare discrete data and t-test for continuous data. P Results A total of 484 patients were reviewed of which 258 (53.1%) had a complete medical record. And 96 (37.2%) filters were placed as permanent at the time of insertion. An additional 40 (15.5%) filters were converted to permanent (total permanent filters 136; 52.7%). Death was reported in 26 (10%) patients and 96 (37.2%) out of the remaining 232 patients presented for potential retrieval. Also, 73 (28.2%) had an attempt to retrieve the filters, 69 (94.5%) were successful and 4 (5.4%) failed to retrieve. The remaining 23 (8.9%) patients declined retrieval. Filters studied include Celect (38%), Bard (31.4%), Option (26.2%), Tulip (4.1%), and Recovery (0.2%). Bard was more commonly used as a retrievable filter (80.9%). Retrieval on the first attempt was 90.4% ( n = 66) successful. Of the remaining seven filters, three were successfully retrieved on a second attempt, and four failed to retrieve due to filter tilt. The success rates of retrieval for Celect and Tulip were significantly lower than for Bard ( p = 0.04 and 0.023, respectively). Conclusion Our study showed that a variety of IVC filters can be retrieved successfully with minimal complication rates. In more than half of our patients, IVC filters were used as permanent. Failure of retrieval was most frequently due to filter tilting.

Background Placement of superior vena cava (SVC) filters has been shown to be both safe and effective in preventing symptomatic pulmonary embolism in patients with upper extremity deep venous thrombosis that have contraindications to anticoagulation therapy. In many patients, existing central lines pose a challenge to SVC filter placement due to the theoretical risk of line displacement and/or entrapment. Purpose To assess the risk of catheter entrapment by filter legs during SVC filter deployment and the risk of subsequent filter migration during catheter removal. Material and Methods A model was created by placing a 22 mm vascular graft inside a plastic tube and submerged in a warm saline bath. Five types of filters were deployed under fluoroscopic guidance over different types of central lines of varying calibers (5–14 Fr). Each filter was deployed five times over each type of central line. The positioning of the legs of the filters in relationship to the central lines was studied by fluoroscopic and direct inspection. The lines were then removed under fluoroscopic guidance noting any line trapping, migration, and/or tilting of the filters. Results Movement of the lines during filter expansion was commonly seen after deployment of all filters with varying frequencies. During line removal slight resistance was encountered with the Celect filter (10%) and the Option filter (5%), while significant resistance was only encountered when using the OptEase filter (20%). Filter migration was only observed when the OptEase filter was deployed over large (>10 Fr) caliber lines (10%). Conclusion When SVC filters are placed over existing central lines, the risk of catheter entrapment is very low in this in-vitro model. Filter migration during line retrieval was only observed when the OptEase filter was placed over >10 Fr caliber lines.

Introduction: Inferior vena cava filters (IVCF) are used liberally in clinical practice and have been associated with multiple complications. Herein, we present results from our institution. Methods: Records of consecutive patients discharged between January 1, 2009 and 2012 were reviewed. Indications were subcategorized under absolute, relative, and prophylactic. Student t test and Kaplan-Meier survival analysis were employed. Results: During this period, 254 vena cava filters (VCF) were placed. Of these, 65 were placed for absolute indication, 28 for relative, and 161 for prophylaxis. Follow-up imaging was available for 96 patients of which 15 showed complications. Successful retrieval of 19 filters was achieved. Conclusion: The study demonstrates that most IVCF are being placed for prophylaxis with low retrieval rate. This contradicts current recommendations. Moreover frequent migration and penetration of IVCF can lead to serious complications. Strict enforcement of IVCF placement guidelines and setting up of filter clinics for timely retrieval is suggested.

The insertion of inferior vena cava filters (IVCF) is a well-known therapy used in the prevention of pulmonary embolism (PE). The incidence of IVCF-related complications is low and complete caval penetration of a filter with adjacent organ injury has a reported incidence of 0–1%. We report the case of an 18-year-old male who sustained a spinal cord injury after a motor vehicle crash. The patient received a prophylactic IVCF and subsequently presented with right flank pain, postprandial nausea, and vomiting. His exam was benign and a computed tomography scan revealed extra-caval penetration of the filter with struts within the duodenal lumen and psoas muscle. The patient underwent an exploratory laparotomy with extraction of the filter, inferior vena cava venorrhaphy, and repair of the duodenal injury. This complication illustrates the potential morbidity of a common procedure and emphasizes the importance of investigating the IVCF as a possible source of abdominal pain.

A primary aortocaval fistula (ACF) is present in less than 1% of all abdominal aortic aneurysms (AAA). The case of a 62-year-old patient with a ruptured AAA and ACF was reported. A stent-graft was implanted into the abdominal aorta. An inferior vena cava filter was inserted to prevent pulmonary embolism. The patient made a smooth recovery. The follow-up computed tomographic scan three months later did not reveal any evidence of endoleaks or that the fistula was still present. Hemodynamic changes with regard to transient acute liver impairment were discovered (renal and liver parameters were presented). Endovascular exclusion appears to be an effective option in the treatment of an aortocaval fistula in comparison to conventional open repair.

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of IVC filters, this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. In this article, we review the various preferred techniques reported in the literature for removal of the entrapped guide wire in particular situations, along with their indications, advantages, and disadvantages. We present simple useful recommendations to prevent this complication.