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Qin L, Tian F, Wang K, Mao Y, Hu L, Xue T, Jia Z, Tao T. A Multidisciplinary Quality Improvement Project Leads to Improved Patient Follow-up and Filter Retrieval Rate. Ann Vasc Surg 2025; 112:373-380. [PMID: 39732325 DOI: 10.1016/j.avsg.2024.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/18/2024] [Accepted: 12/18/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND To identify risk factors for loss to follow-up after inferior vena cava (IVC) filter placement in inpatients of other departments (IODs) and to determine whether a quality improvement project launched at our institution in April 2022 improved follow-up and filter retrieval rates in these patients. METHODS Consecutive patients who underwent retrievable filter placement at our institution between March 2021 and March 2023 were included in this study. Patients were divided into preimprovement (before April 2022; n = 81) and postimprovement (after April 2022; n = 77) groups. Risk factors for loss to follow-up were assessed in the preimprovement group, and filter retrieval rates were compared between groups. RESULTS Acute cerebral hemorrhage (OR = 5.745; 95% CI: 1.471-22.434) and lack of requirement for follow-up by the referring department (OR = 3.435; 95% CI: 1.035-11.398) were identified as independent risk factors for loss to follow-up. The filter retrieval rate was higher in the postimprovement group (94.8%) than in the preimprovement group (69.1%; P < 0.001). The rate of loss to follow-up was lower in the postimprovement group (5.2%) than in the preimprovement group (30.9%; P < 0.001). The preimprovement group had a higher incidence of IVC perforation (9.6%) than the postimprovement group (0; P = 0.019) at the time of filter retrieval. CONCLUSION Acute cerebral hemorrhage and lack of requirement for follow-up by the referring department are independent risk factors for loss to follow-up among IODs. The quality improvement project at our institution improved follow-up and IVC filter retrieval rates in IODs.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Feng Tian
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Youjun Mao
- Department of Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Linghong Hu
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City (Huaian Cancer Hospital), Huai'an, China.
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
| | - Tao Tao
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
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Wang X, Sun C, Liu Y, Tang Y, Yu X, Peng Z, Li C, Yang Q. High thrombus density ratio on CT venography is associated with inferior vena cava filters trapped embolus in patients with deep vein thrombosis. Eur J Radiol 2025; 184:111944. [PMID: 39946815 DOI: 10.1016/j.ejrad.2025.111944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 11/19/2024] [Accepted: 01/19/2025] [Indexed: 03/05/2025]
Abstract
OBJECTIVE Defining the appropriate use of retrievable inferior vena cava filters (RIVCF) in patients with deep vein thrombosis (DVT) remains significant clinical need. This study aimed to investigate the association between thrombus density on computed tomography venography (CTV) and RIVCF-trapped embolus to further identify DVT patients who may benefit from RIVCF implantation. MATERIALS AND METHODS Between 2019 and 2023, 91 DVT patients with RIVCF implantation were prospectively recruited. CTV was performed for all patients. Based on the presence of RIVCF-trapped embolus at filter retrieval, patients were divided into the no-embolus group and the embolus group. The thrombus density ratio was compared between the two groups. Univariate and multivariate logistic regression models and receiver operating characteristic curve analyses were used to identify the association between thrombus density ratio and RIVCF-trapped embolus. RESULTS RIVCF-trapped embolus occurred in 55 patients (60 %). The thrombus density ratio was significantly higher in the embolus group than the no-embolus group (46.23 ± 0.1 % vs. 55 ± 0.08 %, p < 0.001). Logistic regression analysis showed that a high thrombus density ratio was associated with thrombus detachment (OR = 2.36, 95 % CI: 1.29-4.29; p = 0.005). The AUC value of the logistic regression model combined with thrombus density ratio and D-dimer for predicting RIVCF-trapped embolus was 0.882 (p < 0.001), and the thrombus density ratio was 0.841 (95 % CI: 0.75-0.92; p < 0.001). CONCLUSION CT-based high thrombus density ratio could predict RIVCF-trapped embolus in DVT patients, indicating that those patients require aggressive RIVCF placement. CLINICAL RELEVANCE STATEMENT CT-based high thrombus density ratio was associated with RIVCF-trapped embolus, which can be a potential imaging marker to identify patients who may benefit from RIVCF implantation and may contribute to future improvements of RIVCF application guidelines.
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Affiliation(s)
- Xinyu Wang
- Department of Radiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Congrui Sun
- Department of Vascular Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yuehong Liu
- Department of Radiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yichen Tang
- Department of Radiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Xianbo Yu
- CT Collaboration, Siemens Healthineers Ltd., Beijing, China
| | | | - Chunmin Li
- Department of Vascular Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
| | - Qi Yang
- Department of Radiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China; Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China.
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Bai Y, Wang K, Xue T, Jia Z. Intracardiopulmonary migration of inferior vena cava filters: An updated systematic review. J Vasc Surg Venous Lymphat Disord 2025; 13:102009. [PMID: 39613230 DOI: 10.1016/j.jvsv.2024.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 10/30/2024] [Accepted: 11/04/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVE Intracardiopulmonary migration of an inferior vena cava (IVC) filter is an uncommon but potentially life-threatening complication. A previous systematic review including data through 2008 found that the most common cause for migration was operator error and that open thoracotomy was the best first option for management. The aim of this study was to assess the clinical presentation and causes of intracardiopulmonary filter migration, as well as the most commonly used management strategies over the past 15 years. METHODS A systematic search of the literature was conducted to identify studies pertaining to intracardiopulmonary IVC filter migration that were published between November 2008 and June 2024, and data were collected regarding clinical presentation, complications, type and location of filter migration, and management strategies. RESULTS A total of 156 cases of intracardiopulmonary migration of IVC filters were identified in 88 publications. Of the 66 patients whose symptoms status was listed, 50 patients had symptoms and 16 patients were asymptomatic. In the remaining patients, the symptom status was not listed. The most frequently reported symptom was chest pain (68.0%; 34/50). Of the 156 patients, 34 (22.8%) experienced intracardiopulmonary migration of the entire filter body, and the remaining 122 (78.2%) experienced filter fracture with migration of the fractured struts. Complications were reported in 30.1% of patients (47/156); these complications included myocardial injury (n = 37), damage of tricuspid valve (n = 12), and hemopericardium (n = 21). Endovascular (16 filters and 56 struts) or surgical (13 filters and 16 struts) retrieval was the primary management strategy for intracardiopulmonary migration of the filter or fractured strut. CONCLUSIONS The main cause of intracardiopulmonary migration of an IVC filter is filter fracture. Endovascular retrieval is gradually becoming the preferred management option for intracardiopulmonary migration of IVC filters.
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Affiliation(s)
- Yifei Bai
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City, Huai'an, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Changzhou, China.
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Wang C, Liu Q, Xiao D, Chen X, Liu R, Wang S. Laparoscopic-assisted retrieval of inferior vena cava filter: A case report and literature review. Vascular 2025; 33:200-204. [PMID: 38498983 DOI: 10.1177/17085381241241108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The retrieval of inferior vena cava filters beyond the retrieval window poses challenges, requiring alternative techniques. OBJECTIVES To discuss the laparoscopy-assisted retrieval approach for difficult inferior vena cava filters. RESEARCH DESIGN Case report. SUBJECTS A 57-year-old male with a retrievable inferior vena cava filter placed 8 months prior. MEASURES Laparoscopy-assisted retrieval technique utilized after unsuccessful interventional attempts. RESULTS Successful retrieval of the filter despite thickened intimal tissue involvement, with no postoperative complications. CONCLUSIONS Laparoscopy-assisted retrieval offers a direct visual approach for challenging filter removal, proving minimally invasive, safe, and effective.
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Affiliation(s)
| | | | - Dalei Xiao
- Luohe Central Hospital, Luohe City, China
| | | | - Rong Liu
- Luohe Central Hospital, Luohe City, China
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Sheng S, Li Y. Chronic IVC occlusion caused by unopened filter after conversion: case report and literature review. Front Cardiovasc Med 2025; 11:1520836. [PMID: 39949725 PMCID: PMC11821645 DOI: 10.3389/fcvm.2024.1520836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 12/18/2024] [Indexed: 02/16/2025] Open
Abstract
Background The VenaTech Convertible Vena Cava Filter (VTCF) is a device designed for insertion into the inferior vena cava (IVC) to prevent life-threatening pulmonary embolism (PE). Upon removal of its retrieval hook, the filter's legs are intended to expand, forming a stent-like structure that is suitable for long-term residence in the human body. However, in clinical practice, the filtering legs do not always expand fully, and the long-term effects on patients remain insufficiently studied. Materials and methods This report presents the case of a male patient with thrombophilia, in whom the VTCF failed to expand completely after conversion, resulting in IVC occlusion and the development of acute deep vein thrombosis (DVT) in the lower limbs. A review of the relevant literature is also provided. Conclusion The inability of the filtering legs to fully expand after retrieval hook removal highlights a design limitation of the VTCF, necessitating proactive management during conversion to ensure complete expansion. For younger or thrombophilic patients, careful evaluation of the filter's suitability and extended follow-up are crucial to optimize outcomes.
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Affiliation(s)
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gabara C, Montoya-Rodes M, López N, Zamora-Martínez C, Ortiz M, Morancho A, Moisés J, Osorio J, Coloma E, Font C, Jiménez S, Zarco F, Burrel M, Bermúdez P, Barrufet M, Aibar J. Inferior Vena Cava Filters: Adherence to Clinical Practice Guidelines Recommendations, Retrieval Rates, and Filter Complications in a Tertiary Hospital. Angiology 2024; 75:928-936. [PMID: 37470426 DOI: 10.1177/00033197231190184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The present study evaluated the adherence to guideline recommendations regarding the indication for inferior vena cava filter (IVCF) placement, retrieval rates, complications, thrombotic recurrences, and mortality. Patients in whom an IVCF was placed between 2015 and 2020 in a tertiary hospital were retrospectively included. We considered absolute indication of IVCF placement if all the guidelines evaluated agreed on the indication, relative indication if only some guidelines recommended it and without indication if none of the evaluated guidelines recommended it. From the 185 patients included; 47% had an absolute indication, 15% a relative indication, and 38% had no indication. Filter-associated complications and non-removal rates were 12.4% and 41%, respectively. Venous thromboembolism recurrence rate was 17.8%, being filter-associated complications (24.2 vs 9.8%, P = .02) and thrombosis of the inferior cava or iliac veins (12.1 vs 2.6%, P = .03) more frequent in this group. The mortality rate was 40%, with higher mortality risk in patients with co-existing cancer. Previous major bleeding, filter-associated complications, and mortality were associated with a major risk of non-removal. In conclusion, the adherence to guidelines regarding the indication of IVCF placement is still low and IVCF complications are not negligible. This fact is of special concern in the elderly, comorbid, and cancer patients.
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Affiliation(s)
- Cristina Gabara
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Néstor López
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martínez
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Alma Morancho
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jorge Moisés
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jeisson Osorio
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Carme Font
- Oncology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Sonia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Federico Zarco
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Burrel
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Patricia Bermúdez
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Marta Barrufet
- Radiology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Barcelona, Spain
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Liao J, Tan Z, Wu Z. Evolving Landscape of Inferior Vena Cava Filter Utilization: A Comprehensive Bibliometric Analysis. Angiology 2024:33197241273357. [PMID: 39120911 DOI: 10.1177/00033197241273357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
This bibliometric analysis scrutinizes the evolution and current challenges in the use of Inferior Vena Cava (IVC) filters, focusing on trends from 2004 to 2023. Analyzing 2470 records, we report the United States' dominant role, with over half of the studies, and a significant shift towards retrievable filters. Despite technological advancements, controversies persist regarding efficacy, safety, and retrieval issues. Our findings point to the need for refined clinical guidelines and enhanced management strategies to navigate the complex landscape of IVC filter utilization effectively.
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Affiliation(s)
- Jianyu Liao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhimin Tan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Singh SP, Jamal A, Qureshi F, Zaidi R, Qureshi F. Leveraging Generative Artificial Intelligence Models in Patient Education on Inferior Vena Cava Filters. Clin Pract 2024; 14:1507-1514. [PMID: 39194925 DOI: 10.3390/clinpract14040121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/13/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch-Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10-8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch-Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels.
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Affiliation(s)
- Som P Singh
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Aleena Jamal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Farah Qureshi
- Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Rohma Zaidi
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Fawad Qureshi
- Department of Nephrology and Hypertension, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
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Qin L, Wang K, Tian F, Xue T, Jia Z, Li S. A change in strategy for filter choice leads to improved filter retrieval rates. Heart Vessels 2024; 39:640-645. [PMID: 38310515 DOI: 10.1007/s00380-024-02371-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To assess whether a new strategy for the choice of inferior vena cava filter placed would improve filter retrieval rates at our institution. METHODS Consecutive patients who underwent retrievable filter placement for temporary embolic protection between January 2021 and January 2023 were considered for study inclusion. Risk factors for nonretrieval of short-term filters were identified in patients receiving filters between January 2021 and January 2022 (prestrategy group). For patients treated between February 2022 and January 2023 (poststrategy group), a long-term filter was recommended for those with these risk factors, and a short-term filter was recommended for those without these risk factors. RESULTS The study population included 303 patients (prestrategy group, n = 154; poststrategy group, n = 149). Long-term immobilization (odds ratio [OR] = 38.000; 95% confidence interval [CI]: 6.858-210.564), active cancer (OR = 17.643; 95% CI: 5.462-56.993), and venous thromboembolism detected in the intensive care unit (OR = 28.500; 95% CI: 7.419-109.477) were identified as independent risk factors for nonretrieval of short-term filters. The total retrieval rate was significantly higher in the poststrategy group (87.2%) than in the prestrategy group (72.7%; P = 0.002); the short-term filter retrieval rate was also significantly higher in the poststrategy group (84.5%) than in the prestrategy group (68.5%; P < 0.001). CONCLUSION The proposed strategy for filter choice based on risk factors for short-term filter nonretrieval can accurately identify patients who need long-term filter placement while also increasing the retrieval rates for both short-term filters retrieval rates and overall retrieval rates.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Feng Tian
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City (Huaian Cancer Hospital), Huai'an, 223200, China.
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China.
| | - Shaoqin Li
- Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Xinglong road 29, Changzhou, 213003, China.
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Haddad P, Peng J, Drake M, Rahimi M. Inferior Vena Cava Filters: An Overview. Methodist Debakey Cardiovasc J 2024; 20:49-56. [PMID: 38765211 PMCID: PMC11100533 DOI: 10.14797/mdcvj.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 05/21/2024] Open
Abstract
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
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Affiliation(s)
- Paul Haddad
- Houston Methodist Hospital, Houston, Texas, US
| | | | | | - Maham Rahimi
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Sathianathan S, Meili Z, Romero CM, Juarez JJ, Bashir R. Racial and gender disparities in the management of acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2024; 12:101817. [PMID: 38296110 PMCID: PMC11523363 DOI: 10.1016/j.jvsv.2024.101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to assess race and sex disparities in use and outcomes of various interventions in patient with acute pulmonary embolism (PE). METHODS We included 129,445 patients with acute PE from the NIS from January 2016 to December 2019. Rates of inferior vena cava (IVC) filter placement, catheter-directed thrombolysis (CDT), CDT with ultrasound, systemic thrombolysis, surgical embolectomy, percutaneous thrombectomy, extracorporeal membrane oxygenation, and mechanical ventilation were compared between race and sex subgroups, along with length of hospital stay, major bleeding events, mortality, and other adverse events. Multivariate linear regression analysis was used to adjust for variables that were significantly different between race and sex, including demographic factors, comorbidities, socioeconomic factors, and hospital characteristics. RESULTS Compared with White male patients, all subgroups had significantly higher odds of in-hospital mortality highest in Hispanic male patients (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.090-1.640; P < .01). All subgroups also had a higher odds of major bleeding events and increased length of stay. All subgroups also had lower odds of receiving CDT, lowest in Black female patients (OR, 0.740; 95% CI, 0.660-0.820; P < .001) and Hispanic female patients (0.780; 95% CI, 0.650-0.940; P < .001) compared with White male patients. There was no significant difference in the use of systemic thrombolysis among subgroups. CONCLUSIONS Black and Hispanic patients and female patients are less likely to undergo CDT compared with White male patients, in addition to having higher odds of mortality, major bleeding, and increased length of stay after management of PE. Further efforts are needed to mitigate disparate outcomes of PE management at not only an institutional, but at a national, level to promote health care equality.
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Affiliation(s)
- Shyama Sathianathan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Zachary Meili
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Carlos M Romero
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Jordan J Juarez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA.
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12
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López N, Zamora-Martinez C, Montoya-Rodes M, Gabara C, Ortiz M, Aibar J. Comparison of inferior vena cava filter use and outcomes between cancer and non-cancer patients in a tertiary hospital. Thromb Res 2024; 236:136-143. [PMID: 38447420 DOI: 10.1016/j.thromres.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND While accepted indications for the use of inferior vena cava filter (IVCF) in patients with a venous thromboembolism (VTE) have remained stable, their use continues to be frequent. Retrieval rates are still low, being particularly notable in the population with cancer. This study aims to review the rate of adherence to guidelines recommendation and to compare retrieval rates and complications in both cancer and non-cancer patients. METHODS A retrospective study was performed including 185 patients in whom an IVCF was placed in Hospital Clinic of Barcelona. Baseline characteristics, clinical outcomes, and IVCF-related outcomes were analyzed. A strongly recommended indication (SRI) was considered if it was included in all the revised clinical guidelines and non-strongly if it was included in only some. RESULTS Overall, 47 % of the patients had a SRI, without differences between groups. IVCF placement after 29 days from the VTE event was more frequent in the cancer group (46.1 vs. 17.7 %). Patients with cancer (48.1 % of the cohort) were older, with higher co-morbidity and bleeding risk. Anticoagulation resumption (75.3 % vs. 92.7 %) and IVCF retrieval (50.6 % vs. 66.7 %) were significantly less frequent in cancer patients. No significant differences were found regarding IVCF-related complications, hemorrhagic events and VTE recurrence. CONCLUSIONS SRI of IVCF placement was found in less than half of the patients. Cancer patients had higher rates of IVCF placement without indication and lower anticoagulation resumption and IVCF retrieval ratios, despite complications were similar in both groups.
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Affiliation(s)
- Néstor López
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martinez
- Medical Oncology Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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13
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Bhinder J, O'Brien-Irr M, Chang M, Montross B, Khan S, Dosluoglu H, Harris L. Comparison of success and cost after retrieval of two inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2024; 12:101687. [PMID: 37708934 PMCID: PMC11523353 DOI: 10.1016/j.jvsv.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The objective of this study was to help guide inferior vena cava (IVC) filter choices by better understanding the retrieval characteristics, complications, and total costs between two commonly used IVC filters. METHODS All patients who underwent retrieval or attempted retrieval of Denali (Bard Peripheral Vascular) or Option (Argon Medical Devices) IVC filters were identified between March 2016 and October 2021 at a single tertiary care center. Those with imaging studies that permitted evaluation of filter placement, presence or degree of tilt, and/or hooking of the filter into the IVC wall were included in the present study. Filter retrieval success, number of attempts, use of advanced techniques, and fluoroscopy and procedural times were recorded and compared between the two filters. RESULTS A total of 87 patients presented for retrieval of 52 Denali and 35 Option Elite filters during the study period. Denali filters were more likely to be successfully retrieved at the first attempt (94% vs 77%; P = .019). The procedural and fluoroscopy times were shorter for Denali filters (29 minutes vs 63 minutes [P < .001] and 7 minutes vs 25 minutes [P < .001], respectively). Denali filters were less likely to be significantly tilted (≥15○) at retrieval (12% vs 29%; P < .001) or to have the filter hook embedded in the IVC wall (6% vs 40%; P < .001). Tilting of the filter of ≥15○ had no significant effects on the retrieval success rate (no tilt or tilt <15○ vs tilt of ≥15○: 98% vs 100%; P = .58). In contrast, filter hook penetration into the IVC wall significantly reduced successful recovery (41% vs 99%; P < .001). CONCLUSIONS The findings from this study suggest that although the filter designs are similar, a benefit exists in the ease of retrievability of the Denali over the Option filter. We found that tilting and hooking of the filter in the IVC wall occurred significantly more with the Option filter. These factors likely made retrieval more difficult and contributed to the longer procedure and fluoroscopy times.
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Affiliation(s)
- Jasmine Bhinder
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
| | - Monica O'Brien-Irr
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Matthew Chang
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Brittany Montross
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sikandar Khan
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Hasan Dosluoglu
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Linda Harris
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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14
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Zhang W, Cui L, Xie C, Du Z, Mou X, Ke Y, Ma Q, Tian W, Yang Z. Glycocalyx-inspired dynamic antifouling surfaces for temporary intravascular devices. Biomaterials 2024; 304:122427. [PMID: 38100906 DOI: 10.1016/j.biomaterials.2023.122427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Protein and cell adhesion on temporary intravascular devices can lead to thrombosis and tissue embedment, significantly increasing complications and device retrieval difficulties. Here, we propose an endothelial glycocalyx-inspired dynamic antifouling surface strategy for indwelling catheters and retrievable vascular filters to prevent thrombosis and suppress intimal embedment. This strategy is realized on the surfaces of substrates by the intensely dense grafting of hydrolyzable endothelial polysaccharide hyaluronic acid (HA), assisted by an amine-rich phenol-polyamine universal platform. The resultant super-hydrophilic surface exhibits potent antifouling property against proteins and cells. Additionally, the HA hydrolysis induces continuous degradation of the coating, enabling removal of inevitable biofouling on the surface. Moreover, the dense grafting of HA also ensures the medium-term effectiveness of this dynamic antifouling surface. The coated catheters maintain a superior anti-thrombosis capacity in ex vivo blood circulation after 30 days immersion. In the abdominal veins of rats, the coated implants show inhibitory effects on intimal embedment up to 2 months. Overall, we envision that this glycocalyx-inspired dynamic antifouling surface strategy could be a promising surface engineering technology for temporary intravascular devices.
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Affiliation(s)
- Wentai Zhang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Linxian Cui
- Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
| | - Chaoming Xie
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, 610072, China
| | - Zeyu Du
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Xiaohui Mou
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - You Ke
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Qing Ma
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Wenjie Tian
- Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China.
| | - Zhilu Yang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, Department of Cardiology, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China; Department of Cardiology, Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan, 610072, China.
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15
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Shewarega A, Powell TM, Silin D. Protrieve sheath utilization for capturing supra-filter thrombus during a retrieval of thrombosed and embedded IVC filter. CVIR Endovasc 2023; 6:52. [PMID: 37882904 PMCID: PMC10602975 DOI: 10.1186/s42155-023-00397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Inferior vena cava (IVC) filters, while effective in preventing pulmonary embolism, can increase the risk of IVC thrombosis. IVC filter (IVCF) thrombosis can result from emboli getting trapped within the filter, extension of deep vein thrombosis (DVT), or the device's inherent thrombogenicity causing in situ thrombosis. This condition can cause noticeable clinical symptoms and complicate the removal of the filter due to the potential for thromboembolism, often resulting in temporary filters remaining unextracted. This case report highlights a novel approach employed to mitigate the risk of thromboembolism during the procedure by capturing mobilized thrombus proximally to the entrapped IVCF. CASE PRESENTATION A 54-year-old woman with a complex medical history including cerebral palsy, Crohn's disease, and transfusion-dependent iron-deficiency anemia experienced a pulmonary embolism. Due to failed anticoagulation therapy resulting in gastrointestinal bleeding and high transfusion requirements, she underwent placement of an IVCF as a preventive measure against recurrent pulmonary embolism. Three years later, the patient presented with lower extremity swelling and a sudden decline in hemoglobin levels. Diagnostic imaging revealed adherent nonocclusive thrombus within and above the indwelling IVCF. Utilizing the novel Protrieve sheath with the self-expandable Nitinol funnel, successful endovascular removal of the embedded IVCF and adherent thrombus was performed, while mitigating the risk of intraprocedural pulmonary embolism. CONCLUSIONS The successful intraprocedural trapping and removal of mobilized thrombus from the IVCF removal was achieved using the Protrieve sheath and Nitinol funnel. This approach provides a promising solution to reduce the risk of embolization during the removal of thrombosed IVCFs, potentially outweighing the complications associated with filter removal.
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Affiliation(s)
- Annabella Shewarega
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Hufelandstreet 55, 45147, Essen, Germany.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.
| | - Taylor M Powell
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA
| | - Douglas Silin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.
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16
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Sarkisova A, Nangeroni J. An Internal Hernia With Small Bowel Volvulus From an Inferior Vena Cava Filter Wire Strut: A Rare Cause of Acute Abdomen. Cureus 2023; 15:e45499. [PMID: 37859925 PMCID: PMC10584404 DOI: 10.7759/cureus.45499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
The use of inferior vena cava (IVC) filters has been increasingly prevalent. Although they are relatively safe with clear indications, they are not without complications. Late-onset complications include IVC filter migration, IVC wire fracture, wire strut penetration, and perforation of organs in its vicinity. In this report, we present the case of a patient with small bowel volvulus secondary to an IVC wire strut migration, causing tethering of the mesentery and vascular compromise to the small bowel.
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Affiliation(s)
- Anna Sarkisova
- General Surgery, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - James Nangeroni
- General Surgery, Southern Ocean Medical Center - Hackensack Meridian Health, Stafford, USA
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17
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Santos Rodríguez AE, Lopera J. Inferior vena cava filter misplacement with SVC perforation. J Interv Med 2023; 6:140-142. [PMID: 37846336 PMCID: PMC10577063 DOI: 10.1016/j.jimed.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
| | - Jorge Lopera
- The University of Texas Health Science Center at San Antonio, USA
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18
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Sheikh MA, VanAken G, Hyder SN, Giri J. Outpatient Follow-up of Pulmonary Embolism: Putting It all Together. Interv Cardiol Clin 2023; 12:429-441. [PMID: 37290845 DOI: 10.1016/j.iccl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many patients discharged after an acute pulmonary embolism (PE) admission have inconsistent outpatient follow-up and insufficient workup for chronic complications of PE. A structured outpatient care program is lacking for the different phenotypes of chronic PE, such as chronic thromboembolic disease, chronic thromboembolic pulmonary hypertension, and post-PE syndrome. A dedicated PE follow-up clinic extends the organized, systematic care provided to patients with PE via the PERT (Pulmonary Embolism Response Team) model in the outpatient setting. Such an initiative can standardize follow-up protocols after PE, limit unnecessary testing, and ensure adequate management of chronic complications.
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Affiliation(s)
- Muhammad Adil Sheikh
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University, PO Box 19636, Springfield, IL 62794-9636, USA.
| | - Gabriella VanAken
- University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Syed Nabeel Hyder
- Division of Cardiology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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19
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Bajda J, Park AN, Raj A, Raj R, Gorantla VR. Inferior Vena Cava Filters and Complications: A Systematic Review. Cureus 2023; 15:e40038. [PMID: 37287823 PMCID: PMC10243179 DOI: 10.7759/cureus.40038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/09/2023] Open
Abstract
Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.
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Affiliation(s)
- Joe Bajda
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Ann N Park
- Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Aishwarya Raj
- Vascular Surgery, St. George's University School of Medicine, True Blue, GRD
| | - Rhea Raj
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
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20
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Serrano E, Vila-Trias E, Zarco F, Zamora Martínez C, Moisés J, Gómez FM, López-Rueda A. Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables. RADIOLOGIA 2023; 65:230-238. [PMID: 37268365 DOI: 10.1016/j.rxeng.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.
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Affiliation(s)
- E Serrano
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - E Vila-Trias
- Servicio Radiología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - F Zarco
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - J Moisés
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - F M Gómez
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
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21
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Warren RE, Dhruva SS, Kinard M, Neuhaus JM, Redberg RF. Trends in FDA Adverse Events Reporting for Inferior Vena Cava Filters and Estimated Insertions in the US, 2016 to 2020. JAMA Intern Med 2023; 183:271-272. [PMID: 36689213 PMCID: PMC9871941 DOI: 10.1001/jamainternmed.2022.6161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/10/2022] [Indexed: 01/24/2023]
Abstract
This quality improvement study identifies adverse events for inferior vena cava filters and reports changes in adverse event reporting and estimated insertions between 2016 and 2020 in the US.
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Affiliation(s)
- Rachel E. Warren
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sanket S. Dhruva
- Department of Cardiology, University of California, San Francisco, California
- Institute of Health Policy Studies, University of California, San Francisco
- University of California, San Francisco
| | | | - John M. Neuhaus
- University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Rita F. Redberg
- Department of Cardiology, University of California, San Francisco, California
- Institute of Health Policy Studies, University of California, San Francisco
- University of California, San Francisco
- Editor, JAMA Internal Medicine
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22
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Stevens H, Bortz H, Chao S, Ramanan R, Clements W, Peter K, McFadyen JD, Tran H. Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement. Res Pract Thromb Haemost 2023; 7:100040. [PMID: 36852111 PMCID: PMC9958400 DOI: 10.1016/j.rpth.2023.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices. Objectives To determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism. Methods Ambidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status. Results Overall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06-15.84). Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%-73.5%, respectively; (OR, 2.50; 95% CI, 1.67-3.78). The MDST was associated with a shorter median time-to-filter retrieval (187-150 days, hazard ratio, 1.78; 95% CI, 1.39-2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality. Conclusion Our study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.
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Affiliation(s)
- Hannah Stevens
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Correspondence Hannah Stevens, Department of Clinical Haematology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia. @hannahpstevens
| | - Hadley Bortz
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Sharon Chao
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Radha Ramanan
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia,Department of Surgery, Monash University Central Clinical School, Melbourne, Australia,National Trauma Research Institute, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Department of Cardiology, Alfred Hospital, Melbourne, Melbourne, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - James D. McFadyen
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - Huyen Tran
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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23
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Sheahan KP, Tong E, Lee MJ. A review of inferior vena cava filters. Br J Radiol 2023; 96:20211125. [PMID: 35856774 PMCID: PMC10997026 DOI: 10.1259/bjr.20211125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/20/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.
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Affiliation(s)
| | - Emma Tong
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
| | - Michael J. Lee
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
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24
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Ramachandran R, Kumar V, Grantham T, Etienne D, Reddy M. Conservative Management of Duodenal Penetration by Inferior Vena Cava Filter: Case Report and Review. J Investig Med High Impact Case Rep 2023; 11:23247096231192815. [PMID: 37610107 PMCID: PMC10460035 DOI: 10.1177/23247096231192815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Duodenal penetration is a late complication associated with the placement of inferior vena cava (IVC) filters. In this case report, we are presenting a case of asymptomatic duodenal penetration by IVC filter that was managed conservatively.
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Affiliation(s)
| | - Vikash Kumar
- Department of Internal Medicine, The Brooklyn Hospital Center, NY, USA
| | - Tyler Grantham
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Denzil Etienne
- Department of Gastroenterology, The Brooklyn Hospital Center, NY, USA
| | - Madhavi Reddy
- Department of Gastroenterology, The Brooklyn Hospital Center, NY, USA
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25
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San Valentin EMD, Barcena AJR, Klusman C, Martin B, Melancon MP. Nano-embedded medical devices and delivery systems in interventional radiology. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1841. [PMID: 35946543 PMCID: PMC9840652 DOI: 10.1002/wnan.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/31/2023]
Abstract
Nanomaterials research has significantly accelerated the development of the field of vascular and interventional radiology. The incorporation of nanoparticles with unique and functional properties into medical devices and delivery systems has paved the way for the creation of novel diagnostic and therapeutic procedures for various clinical disorders. In this review, we discuss the advancements in the field of interventional radiology and the role of nanotechnology in maximizing the benefits and mitigating the disadvantages of interventional radiology theranostic procedures. Several nanomaterials have been studied to improve the efficacy of interventional radiology interventions, reduce the complications associated with medical devices, improve the accuracy and efficiency of drug delivery systems, and develop innovative imaging modalities. Here, we summarize the recent progress in the development of medical devices and delivery systems that link nanotechnology in vascular and interventional radiology. This article is categorized under: Diagnostic Tools > Diagnostic Nanodevices Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease.
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Affiliation(s)
- Erin Marie D San Valentin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
| | | | - Carleigh Klusman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Benjamin Martin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Marites P Melancon
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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Muacevic A, Adler JR. Effectiveness and Safety of Laser-Assisted Removal of Inferior Vena Cava (IVC) Filters in a Single Tertiary Care Center. Cureus 2022; 14:e32809. [PMID: 36570113 PMCID: PMC9773150 DOI: 10.7759/cureus.32809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Laser sheath-assisted removal of inferior vena cava (IVC) filters with long dwelling time is a technique that utilizes laser-tipped sheaths. The laser light only penetrates vascular tissue by one hundred microns, causing the target tissues to disintegrate into particles less than 5 microns in size. This approach reduces the energy used during difficult retrieval procedures, allowing permanent filters to be removed in less fluoroscopic and procedural time overall. MATERIALS AND METHODS The radiology information system and electronic health records were used in this retrospective cohort study to retrieve the data. A total of nine consecutive patients who underwent laser-assisted filter removal utilizing GlideLightTM were included in the study between January 2016 and January 2017. The study took place at King Abdulaziz Medical City in Riyadh. In this study, five patients were male and four were female with ages ranging from 19 to 57 years with a median age of 31. RESULTS During the period of the study, a total of nine patients had their IVC filters removed using a laser. The success rate was 100%. The indications were trauma (n=4) followed by deep vein thrombosis (DVT) (n=3) and one patient indication was prolonged immobilization. The dwelling time ranged from seven to 70 months, with a dwelling median of 19 months. CONCLUSION A laser sheath might be necessary for closed-cell filters in order to improve the likelihood of a successful and secure retrieval. Technical efficiency, filter type, the necessity of applying a laser sheath based on an open versus closed filter design, dwell times, and unfavorable results. As a result, after typical procedures failed to successfully retrieve IVC filters with long dwell durations, laser-assisted filter removal is thought to be practical and safe.
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Escobar A, Salem AM, Dickson K, Johnson TN, Burk KJ, Bashoura L, Faiz SA. Anticoagulation and bleeding in the cancer patient. Support Care Cancer 2022; 30:8547-8557. [PMID: 35579752 PMCID: PMC9529787 DOI: 10.1007/s00520-022-07136-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
Cancer patients have an increased risk of bleeding compared to non-cancer patients with anticoagulant therapy. A bleeding risk assessment before initiation of anticoagulation is recommended. Currently low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) are the mainstays of treatment for cancer-associated venous thromboembolism (VTE). Since DOACs are administered orally, they offer some convenience and ease of administration; however, LMWH may be preferred in certain cancers. Given the prevalence of anticoagulant therapies in cancer patients, clinical providers must be able to recognize potentially critical bleeding sites and modalities to reverse major hemorrhage. Reversal agents or antidotes to bleeding may be required when bleeding is persistent or life-threatening. These include vitamin K, fresh frozen plasma (FFP), protamine, prothrombin complex concentrate (PCC) or andexanet alfa, and idarucizumab. Inferior vena cava (IVC) filter insertion can be also considered in those with major bleeding. Evidence for timing and need for re-initiation of anticoagulant therapy after a major bleeding remains sparse, but a multi-disciplinary approach and shared decision-making can be implemented in the interim.
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Affiliation(s)
- Andres Escobar
- Divisions of Critical Care, Pulmonary and Sleep Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Ahmed M Salem
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kodwo Dickson
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tami N Johnson
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathyrn J Burk
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Unit 1462, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Unit 1462, P.O. Box 301402, Houston, TX, 77030-1402, USA.
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Fleitas Sosa D, Lehr AL, Zhao H, Roth S, Lakhther V, Bashir R, Cohen G, Panaro J, Maldonado TS, Horowitz J, Amoroso NE, Criner GJ, Brosnahan SB, Rali P. Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/165/220023. [PMID: 35831010 DOI: 10.1183/16000617.0023-2022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain. OBJECTIVE To determine the effect of PERTs in the management and outcomes of patients with PE. METHODS PubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model. RESULTS 16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74-2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88-1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58-0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71-1.07; p=0.19) with PERTs. CONCLUSIONS The PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.
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Affiliation(s)
- Derlis Fleitas Sosa
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA .,Both authors contributed equally
| | - Andrew L Lehr
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA.,Both authors contributed equally
| | - Huaqing Zhao
- Dept of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Stephanie Roth
- Biomedical and Research Services Librarian, Simmy and Harry Ginsburg Library, Temple University, Philadelphia, PA, USA
| | - Vlad Lakhther
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Riyaz Bashir
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gary Cohen
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Panaro
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Parth Rali
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Lee C, Stavropoulos SW, Kuo WT. Routine Removal of Inferior Vena Cava Filters. N Engl J Med 2022; 386:2149-2151. [PMID: 35648711 DOI: 10.1056/nejmclde2118538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Inferior vena cava filters are an important therapeutic option for patients with venous thromboembolism and contraindication to anticoagulation. Indications for filter placement have varied over the previous decades. This article discusses the history of inferior vena cava filter use, with a basic overview of technology and specific devices. Finally, this article reviews emerging filter design and technology. Understanding the basics of inferior vena cava filters is critical to building more robust clinical data for the purpose of improving patient outcomes.
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Affiliation(s)
- Brian Covello
- Department of Interventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
| | - Martin Radvany
- Department of Neurointerventional Radiology, Aventura Hospital and Medical Center, Aventura, Florida
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Hsu PY, Wu EB. Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report. World J Clin Cases 2022; 10:5111-5118. [PMID: 35801013 PMCID: PMC9198887 DOI: 10.12998/wjcc.v10.i15.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (APE) is a rare and potentially life-threatening condition, even with early detection and prompt management. Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.
CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava (IVC) tumor thrombus. APE that occurred during tumor thrombectomy with hypercapnia and desaturation. The capnography combined with the transesophageal echocardiography (TEE) provided a crucial differential diagnosis during the operation. The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability. He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist. There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.
CONCLUSION Under general anesthesia for IVC tumor thrombus surgery, a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE, which occurs before hemodynamic changes. When intraoperative APE is suspected, TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram. Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.
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Affiliation(s)
- Pei-Yu Hsu
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - En-Bo Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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Edupuganti S, Li M, Wu Z, Basu T, Barnes GD, Carrier M, Sood SL, Griggs JJ, Schaefer JK. Factors Associated With Inferior Vena Cava Filter Placement and Retrieval for Patients With Cancer-Associated Thrombosis. Am J Med 2022; 135:478-487.e5. [PMID: 34861200 DOI: 10.1016/j.amjmed.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Venous thromboembolism is a leading cause of death in patients with cancer. Inferior vena cava filters are utilized to mitigate the risk of pulmonary embolism for patients who have contraindication to, or failure of, anticoagulation. METHODS We reviewed an insurance claims database to identify adults receiving cancer-directed therapy and had a new diagnosis of venous thromboembolism. We then evaluated clinical and sociodemographic characteristics in patients with and without filter placement and retrieval. RESULTS There were 25,788 patients (mean [SD] age: 68.3 [12.7] years) who met the study inclusion criteria, with 2111 individuals (8.2%) undergoing filter placement. Filter placement was associated with the type of thrombosis, malignancy, recent surgery, comorbidities, and income. A total of 137 patients (6.5%) newly started anticoagulation within 3 days of filter placement, and 612 (29%) patients received anticoagulation within 30 days after filter placement. Despite this, only 159 (7.5%) patients had their filters retrieved during the study period. Patients with income of $75-99K (odds ratio 2.13, P = .012) or above $100K (odds ratio 1.8, P = .038) were more likely to have filter retrieval compared with those with income <$50K. Filter retrieval was also more likely in younger patients and those with fewer comorbidities or without central nervous system or lung malignancies. CONCLUSIONS Inferior vena cava filter placement and retrieval are associated with several sociodemographic factors. Filter retrieval rates are low despite re-initiation of anticoagulation in many patients. Efforts are needed to address disparities in filter use and improve retrieval rates.
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Affiliation(s)
| | | | - Zhenke Wu
- Department of Biostatistics; Michigan Institute for Data Science; Institute for Social Research
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ont, Canada
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jennifer J Griggs
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor.
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Nagraj S, Li W, Zamora C, Barakakis PA, Kokkinidis DG. Pharmacological and interventional management of pulmonary embolism: where do we stand? Future Cardiol 2022; 18:191-206. [PMID: 35133192 DOI: 10.2217/fca-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
As the third most common cardiovascular disease, pulmonary embolism (PE) has an uptrending incidence and mortality, resulting in significant healthcare expenditure. Risk stratification of acute PE guides management. Although anticoagulation remains the cornerstone management, systemic fibrinolysis and targeted therapeutic approaches, catheter-directed thrombolysis and catheter-based embolectomy are available for high-risk patients. Life-threatening bleeding complications associated with systemic fibrinolysis have restricted its widespread implementation. Catheter-based techniques for intermediate high-risk categories were devised to reduce bleeding complications and improve outcomes. Catheter-directed thrombolysis helps minimize bleeding by way of direct drug delivery. Catheter-based embolectomy mechanically retrieves thrombi without using fibrinolytics. This focused review of medical and interventional management of acute PE provides a highlight of ongoing trials expected to add value to current practice.
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Affiliation(s)
- Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Weijia Li
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Cristian Zamora
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | | | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, CT 06510, USA
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Weng CX, Wang SM, Wang TH, Zhao JC, Yuan D. Successful management of infected right iliac pseudoaneurysm caused by penetration of migrated inferior vena cava filter: A case report. World J Clin Cases 2021; 9:9211-9217. [PMID: 34786407 PMCID: PMC8567519 DOI: 10.12998/wjcc.v9.i30.9211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/17/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Indwelling inferior vena cava (IVC) filters might cause various complications, including filter penetration, filter fracture, filter migration, and thrombosis of the IVC. Penetration and migration complications are common, while a caudal migrated double-basket filter with associated infected iliac pseudoaneurysm has seldom been reported.
CASE SUMMARY We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 mo. The patient had a history of failed endovascular IVC filter retrieval. Computed tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein, leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis, and bilateral iliac veins were occluded. Emergency open repair was performed to remove the IVC filter, the right iliac pseudoaneurysm, and the compromised segments of the iliac veins and IVC with right common iliac artery reconstruction. Staphylococcus aureus was isolated from the tissue culture. The patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after discharge. Six-month follow-up computed tomography revealed that the right common iliac artery was patent, and only mild hydronephrosis was detected.
CONCLUSION An indwelling IVC filter, even ‘embedded’ within organized thrombus, could still cause life-threatening complications. Open procedures remain the last resort for IVC filters with severe complications.
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Affiliation(s)
- Cheng-Xin Weng
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shu-Min Wang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tie-Hao Wang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Chun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Omedè P, Bocchino PP, De Filippo O, D’Ascenzo F. Patent foramen ovale closure in a patient with vena cava filter: a case report. Eur Heart J Case Rep 2021; 5:ytab284. [PMID: 34377917 PMCID: PMC8343425 DOI: 10.1093/ehjcr/ytab284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/23/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
Background The presence of a patent foramen ovale (PFO) is associated with several medical conditions, including cryptogenic left circulation thromboembolism. PFO closure was demonstrated to reduce recurrent ischaemic stroke in patients with prior cryptogenic stroke. The presence of an inferior vena cava filter (IVCF), however, may impede a transfemoral PFO closure procedure. Case summary We describe the case of a 50-year-old man with a PFO suffering from ischaemic stroke from paradoxical thromboembolism originating from deep vein thrombosis and requiring an IVCF. After deep vein thrombosis resolution, due to the high risk of stroke recurrences, the patient was recommended PFO closure. IVCF retrieval by the interventional radiologist was first attempted but failed. A transfemoral PFO closure procedure was thus endeavoured with the IVCF in place and was successful. The patient was then discharged in good clinical status and no stroke recurrences were reported at 5 months follow-up. Discussion Albeit an IVCF provides benefit in patients with recurrent thromboembolic events despite adequate anticoagulation therapy, its presence may hinder interventional procedures necessitating delivery systems to advance through the inferior vena cava. We reported on a successful PFO closure procedure via a femoral venous access in a patient with an IVCF in place, thus demonstrating the feasibility of advancing delivery systems through an IVCF. As interventional procedures requiring the advancement of delivery systems through the inferior vena cava are becoming increasingly common, the feasibility of IVCF crossing with catheters and delivery systems alike paves the way for novel interventional possibilities.
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Affiliation(s)
- Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, University of Turin, “Città della Salute e della Scienza” Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, University of Turin, “Città della Salute e della Scienza” Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, University of Turin, “Città della Salute e della Scienza” Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, “Città della Salute e della Scienza” Hospital, Corso Bramante 88/90, 10126 Turin, Italy
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Singh M, Shafi I, Rali P, Panaro J, Lakhter V, Bashir R. Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:44. [PMID: 33994774 PMCID: PMC8113788 DOI: 10.1007/s11936-021-00920-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/21/2023]
Abstract
Introduction Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients. Purpose of review The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic. Recent findings There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging. Summary Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.
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Affiliation(s)
- Maninder Singh
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA
| | - Irfan Shafi
- Department of Internal Medicine, Wayne State University/DMC, Detroit, MI USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA USA
| | - Joseph Panaro
- Department of Radiology, Temple University Hospital, Philadelphia, PA USA
| | - Vladimir Lakhter
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA
| | - Riyaz Bashir
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA.,Division of Cardiovascular Diseases, Temple University Hospital, 3401 N. Broad Street (9PP), Philadelphia, PA 19140 USA
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