Indications, management, and complications of temporary inferior vena cava filters.
ABSTRACT We describe the results of a preliminary prospective study using different recently developed temporary and retrievable inferior vena cava (IVC) filters.
Fifty temporary IVC filters (Günther, Günther Tulip, Anthéor) were inserted in 47 patients when the required period of protection against pulmonary embolism (PE) was estimated to be less than 2 weeks. The indications were documented deep vein thrombosis (DVT) and temporary contraindications for anticoagulation, a high risk for PE, and PE despite DVT prophylaxis.
Filters were removed 1-12 days after placement and nine (18%) had captured thrombi. Complications were one PE during and after removal of a filter, two minor filter migrations, and one IVC thrombosis.
Temporary filters are effective in trapping clots and protecting against PE, and the complication rate does not exceed that of permanent filters. They are an alternative when protection from PE is required temporarily, and should be considered in patients with a normal life expectancy.
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ABSTRACT: To determine the safety and performance of a new inferior vena cava (IVC) filter in an ovine model and evaluate the retrievability at 5 weeks. The Crux Vena Cava Filter (VCF) is composed of 2 nitinol spiral supports with a polymeric filter suspended between them. Retrieval tails on each end facilitate retrieval. Twelve filters were placed in the infrarenal IVCs of 12 sheep. The vessels were imaged pre and post deployment to assess acute device performance. At 5 weeks, the vessels were re-imaged to evaluate continued device performance and vessel integrity. Nine of 12 filters were retrieved, and the animals were returned to their housing. The other 3 animals were sacrificed, and the filters and vessels were processed for gross and histological examination. At 9 weeks, 4 weeks after filter retrieval, vessel integrity of the remaining 9 animals was again assessed under fluoroscopy. The animals were sacrificed, and the IVCs were explanted for study. All 12 filters were implanted without complications at the intended deployment site and remained fixed over the implantation period. At 5 weeks, the filters intended for recovery were successfully retrieved, with a mean capture time of 9.6+/-13.7 minutes. There were no complications during the 4-week follow-up after filter retrieval. Post-retrieval imaging at 5 and 9 weeks showed no visible signs of vessel wall damage. Histological study of 3 explanted vessels and filters revealed slight neointima encapsulation of the filter elements and minimal incorporation. Gross examination of the post-retrieval vessel walls after the 4-week healing period showed minimal superficial vessel damage; histology showed minimal residual signs of hemorrhage, with little to no inflammatory reaction. The Crux VCF was deployed and safely retrieved without incident at 5 weeks in an animal model. There was no significant damage seen to the IVCs 1 month after filter retrieval.Journal of Endovascular Therapy 07/2008; 15(3):292-9. · 2.86 Impact Factor
Article: Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction.[show abstract] [hide abstract]
ABSTRACT: The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.Neurosurgical FOCUS 11/2004; 17(4):E6. · 2.87 Impact Factor
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ABSTRACT: Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, represents a significant source of morbidity and mortality in the United States and worldwide. The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. Cumulative clinical experience gained from using these 2 classes of antithrombotic agents for the prevention and treatment of venous thromboembolism in high-risk patients pointed to a number of efficacy and safety limitations. This prompted further research and the eventual introduction, in the 1980s, of low-molecular-weight heparin(s) as a potentially superior therapeutic modality. Within the last decade the pace of development of newer classes of antithrombotic agents for venous thromboembolism prevention and treatment (as well as other indications) has accelerated. Among agents at late stages of investigation are ximelagatran (a direct thrombin inhibitor), nematode anticoagulant peptide c2 (a tissue factor VIIa inhibitor), and sodium N-[8(2-hydroxylbenzoyl)amino]caprylate (SNAC)/heparin (a heparin derivative). The most recently approved agents for venous thromboembolism indications include the heparinoid, danaparoid sodium, and the newly introduced selective factor Xa inhibitor, fondaparinux.Archives of Internal Medicine 05/2003; 163(7):759-68. · 11.46 Impact Factor