A first attempt of inferior vena cava filter successfully guided by a mixed-reality system: a case report

Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carry a high risk of injury because of the radiation and contrast agent.Patients with nephrotic syndrome(NS)or some other renal diseases may prone to thrombosis due to the excretion of protein C and protein S overmuch.So,it is necessary to develop a new therapy without contrast agent.Mixed-reality(MR)is a new technology as a guidance of inferior vena cava filter implantation exposed under no X-ray and required no contrast agent.

Vena cava thrombosis after vena cava filter placement： Incidence and risk factors

Background The objective of this study was to assess the clinical safety and efficacy of vena cava filter （VCF） placement, with particular emphasis on the incidence and risk factors of inferior vena cava thrombosis （VCT） after VCF placement. Methods Clinical data of patients with venous thromboembolism （VTE）, with or without placement of VCF, were analyzed in a retrospective single-center audit of medical records from January 2005 to June 2009. The collected data included demographics, procedural details, filter type, indications, and complications. Results A total of 168 cases of VTE （82 with VCF; 86 without VCF） were examined. Over a median follow-up of 24.2 months, VCT occurred in 18 of 82 patients with VCFs （11 males, 7 females, mean age 55.4 years）. In 86 patients without VCFs, VCT occurred in only 6 individuals （4 males, 2 females） during the study period. VCT was observed more frequently in patients fitted with VCFs than in those without VCFs （22% vs. 7.0%）. Conclusions The incidence of VCT in patients with VTE after VCF implantation was 22% approximately. Anticoagulation therapy should be continued for all patients with VCF placement, unless there is a specific contraindication. Almost all instances of VCT in patients with VCF implants in our study occurred after stopping anticoagulation treatment. The use of VCFs is increasing, and more trials are needed to confirm their benefit and accurately assess their safety.

Retroperitoneal hematoma after implantation of double inferior vena cava filters

A 55-year-old man developed deep venous thrombosis and inferior vena cava(IVC) thrombosis 7 years earlier and was treated by placement of a permanent IVC filter. One week ago, he was admitted with bilateral lower limb swelling and pain. Digital subtraction angiography showed a filling defect above the original filter. A retrievable Tulip filter was placed and catheter-directed thrombolysis was performed. Six days later, the patient experienced sudden, persistent upper right abdominal pain, and a computed tomography scan revealed the formation of retroperitoneal hematoma. Symptomatic treatments were administered, and the hematoma gradually resolved during follow-up.

Comparative outcomes of Inferior Vena Cava filters placed at bedside using digital radiography versus conventional fluoroscopy

Purpose:To retrospectively assess the outcomes of Inferior Vena Cava(IVC)filters placed in critically ill patients in the ICU at bedside using digital radiograph(DR)guidance with previous cross-sectional imaging for planning,compared to IVC filters placed by conventional fluoroscopy(CF).Method and materials:The cohort consisted of 129 IVC filter placements;48 placed at bedside and 81 placed conventionally from July 2015 to September 2016.Patient demographics,indication,radiation exposures,access site,procedural duration,dwell time,and complications were identified by the EMR.IVC Filter positioning with measurements of tip to renal vein distance and lateral filter tilt were performed when cavograms or post placement CTs were available for review.Statistical analysis was performed using Stata IC 11.2.Results:Technical success of the procedure was 100% in both groups.Procedural duration was longer at the bedside lasting 14.5+/-10.2 versus 6.7+/-6.0 min(p<0.0001).The bedside DR group had a median radiation exposure of 25 mGy(15-35)and the CF group had mean radiation exposure of 256.94 mGy+/-158.6.There was no significant difference in distance of IVC tip to renal vein(p=0.31),mispositioning(p=0.59),degree of filter tilt(p=0.33),or rate of complications(p=0.65)between the two groups.Conclusion:IVCF placement at the bedside using DR is comparable to CF with no statistical difference in outcomes based on IVCF positioning,degree of lateral tilt or removal issues.It decreased radiation dose,but with overall increased procedural time.

Fracture Rate and Serious Complications of Vena Cava Filters

Purpose: To retrospectively evaluate the prevalence of fracture and fragment embolization of inferior vena cava (IVC) filters. Methods: Electronic medical records and imaging studies of all Kaiser Permanente patients who received IVC filters from August 2000 until August 2010 were retrospectively reviewed for filter complications. Results: 283 patients received an IVC filter during the study period. 143 patients were deceased, while 140 are living. Among deceased patients, the average age at the time of death was 69.8 ± 15.3 [range: 24.7 - 99.2] years;55.9% were men;the mean implantation-to-image time was 13.6 ± 20.6 [range: 0 - 92.4] months, and there were no reported major complications attributable to filter migration or fracture at a mean of 16.8 ± 24.8 [range: 0 - 119.6] months following implantation. One of 14 (7.1%) G2 filters perforated the aorta, which already had a stent graft in place. Among those patients still living, the average age was 67.3 ± 15.2 [range: 15.2 - 97.3] years, 47.1% were men, the mean implantation-to-image time was 33.3 ± 36.5 [range: 0.1-141.7] months, and there were no reported major complications at a mean of 35.3 ± 36.5 [range: 0 - 141.7] months following implantation. Three of 60 (5.0%) Trapease filters were found to have at least 1 strut fracture. There were no cases of filter migration or fragment embolization. The overall fracture rate of all filters with an implantation-to-image-time greater than two years (mean implantation-to-image time 4.7 ± 2.7 [range: 2.0 - 11.8] years) was 3 of 67 (4.5%). Bard G2 and G2X filters had a 0% fracture and embolization rate at a mean of 19.0 ± 16.6 [range: 0.07 - 49.5] months after implantation. Conclusions: IVC filters, regardless of type, have a low prevalence of fracture and we found no cases of fragment embolization.

Incidental echocardiographic finding:Fractured inferior vena cava filter

Inferior vena cava filters have gained increasing popularity in recent decades and knowledge on rare complications becomes vital to practicing physicians. A 30-year-old African American male with diabetes mellitus, hypertension, end-stage renal disease, history of deep venous thrombosis and placement of venacaval filter who was seen in the cardiology clinic for cardiac risks stratification prior to renal transplant. Patient denied any cardiac symptoms. A transthoracic echocardiogram was performed and showed two linear echoes bright densities in the right atrium and right ventricle embedded which was later found to be fractured filter struts by computed tomography. We discuss the various outcomes associated with nonretrieval of retrievable inferior vena cava filters.

Successful management of infected right iliac pseudoaneurysm caused by penetration of migrated inferior vena cava filter:A case report

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.

Thrombus Propagation across an Inferior Vena Cava Filter Resulting in Fatal Pulmonary Embolism: A Case Report

Inferior vena cava (IVC) filters have since been implanted in the 1970s. The aim of implantation is to prevent the occurrence of fatal pulmonary embolism (PE). However, fatal pulmonary embolisms have been occurring after filter insertion. The mechanism is that either a thrombus or an embolus was already located cranial to the site of deployment of the filter within the inferior vena cava. And so after the filter implantation significant embolism can still occur. We present the case of a 62-year-old woman who had an IVC filter but died two weeks later from pulmonary embolism, through an unusual mechanism. The patient had a fracture of the left tibia, had open reduction and internal fixation developed pulmonary embolism secondary to deep vein thrombosis of the left lower limb. Anticoagulation was started, an IVC filter was inserted and she was discharged home with a therapeutic INR. However, she passed away two weeks later from pulmonary embolism, through the unusual mechanism of thrombus propagation across the IVC filter. The clinical significance of this article is to draw clinicians’ attention to the existence of another mechanism of fatal pulmonary embolism after an IVC filter insertion. The thrombus can propagate across the IVC filter leading to fatal pulmonary embolism.

A new type of inferior vena cava filter and its animal experiment

This article explains the definition of pulmonary embolism as well as its causes and elaborates on a new type of inferior vena cava filter(VCF)we have developed. Shaped like a waistdrum, the VCF is mainly made of TiNi shape memory alloy-wire. It has a subulate wire frame which can intercept the thrombus on each side. Its medial body is made up of straight shape memory alloy-wire . Every pillar is bound by several shape memory alloy springs. This type of inferior vena cava filter has a good resistance to fatigue and is hard to be broken. Through animal experiments its framework has been proved to be lasting. Neither deformation nor fragmentation happened when the VCF had been kept in the body for a long time. The thrombus interception efficiency of our VCF is higher than imported VCFs. The filter is unfavorable for thrombosis. After implantation, the IVC was completely unimpeded and no displacement occurred. Moreover the VCF did little damage to the Wall of vein. Neither IVC perforation nor haematoma occurred after the operation.

Clinical outcomes of Angio Jet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis

BACKGROUND The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism(PE).However,filter-related thrombosis is a complication of filter implantation.Endovascular methods such as AngioJet rheolytic thrombectomy(ART)and catheter-directed thrombolysis(CDT)can treat filter-related caval thrombosis,but the clinical outcomes of both treatment modalities have not been determined.AIM To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis.METHODS In this single-center retrospective study,65 patients(34 males and 31 females;mean age:59.0±13.43 years)with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022.These patients were assigned to either the AngioJet group(n=44)or the CDT group(n=21).Clinical data and imaging information were collected.Evaluation measures included thrombus clearance rate,periprocedural complications,urokinase dosage,incidence of PE,limb circumference difference,length of stay,and filter removal rate.RESULTS Technical success rates were 100%in the AngioJet and CDT groups.In the AngioJet group,grade II and grade III thrombus clearance was achieved in 26(59.09%)and 14(31.82%)patients,respectively.In the CDT group,grade II and grade III thrombus clearance was accomplished in 11(52.38%)patients and 8(38.10%)patients,respectively(P>0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment(P<0.05).The median dosage of urokinase was 0.08(0.02,0.25)million U in the AngioJet group and 1.50(1.17,1.83)million U in the CDT group(P<0.05).Minor bleeding was shown in 4(19.05%)patients in the CDT group,and when it was compared with that in the AngioJet group,the difference was statistically significant(P<0.05).No major bleeding occurred.Seven(15.91%)patients in the AngioJet group had hemoglobinuria and 1(4.76%)patient in the CDT group had bacteremia.There were 8(18.18%)patients with PE in the AngioJet group and 4(19.05%)patients in the CDT group before the intervention(P>0.05).Computed tomography angiopulmonography(CTA)showed that PE was resolved after the intervention.New PE occurred in 4(9.09%)patients in the AngioJet group and in 2(9.52%)patients in the CDT group after theintervention(P>0.05).These cases of PE were asymptomatic.The mean length of stay was longer in the CDT group(11.67±5.34 d)than in the AngioJet group(10.64±3.52 d)(P<0.05).The filter was successfully retrieved in the first phase in 10(47.62%)patients in the CDT group and in 15(34.09%)patients in the AngioJet group(P>0.05).Cumulative removal was accomplished in 17(80.95%)out of 21 patients in the CDT group and in 42(95.45%)out of 44 patients in the ART group(P>0.05).The median indwelling time for patients with successful retrieval was 16(13139)d in the CDT group and 59(12231)d in the ART group(P>0.05).CONCLUSION Compared with catheter-directed thrombolysis,AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects,improve the filter retrieval rate,reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

High Inferior Vena Cava Thrombosis in a 16-year-old Postpartum Patient:A Case Report

Postpartum inferior vena cava (IVC) thrombosis is a rare,but potentially life-threatening disorder.Here we reported one case of the youngest woman to date who presented with massive IVC thrombus extending from deep veins of the right leg to the level of the 11th thoracic vertebra,associated with asymptomatic pulmonary embolism.

DVT的危险因素及VCFs保护下治疗下肢DVT疗效的分析

目的探讨DVT形成的危险因素及滤器保护下治疗DVT的疗效。方法对2003年1月至2006年12月83例下肢DVT病例予滤器保护下溶栓抗凝治疗,对DVT危险因素及疗效进行总结。结果1.病人年龄60岁以上者65.6%;3个月内骨盆或DVT患肢的创伤/骨折占12.0%,有手术史者14.5%,91.6%位于腹盆腔及患肢;有恶性肿瘤史者19.3%,75%位于腹盆腔。2.滤器植入均成功,无移位及穿孔,总有效率98.8%;滤器俘获栓子19例,2例有PE症状,PE发生可能性减少20.5%。结论年龄、创伤/骨折、恶性肿瘤是DVT的重要危险因素;VCFs保护下治疗下肢DVT可有效预防PE。

TempofilterⅡ滤器在肾癌伴静脉癌栓手术治疗中的应用(附18例报告)

目的总结肾癌合并静脉癌栓行根治手术前,预先植入TempofilterⅡ临时滤器预防肺栓塞的效果。方法回顾性分析2013年1月至2016年5月18例确诊为肾癌合并静脉癌栓的患者资料,预先植入TempofilterⅡ临时滤器,后行肾癌切除和静脉癌栓取栓术,并于术中或术后取出滤器。肾静脉及下腔静脉癌栓分级：0级4例,Ⅰ级2例,Ⅱ级10例,Ⅲ级2例。结果全部患者先行植入下腔静脉TempofilterⅡ临时滤器,技术成功率100%,无相关围术期并发症发生。术后取出临时滤器时间间隔为0~9天[平均为（4.1±2.5）天]。取出的滤器均形态完整,无滤丝折断、滤器移位发生。1例患者于滤器取出术后3个月发现颈部皮肤转移癌。结论对于肾癌合并静脉癌栓患者,预先植入TempofilterⅡ临时滤器预防肺栓塞是安全、可行的。滤器取出过程需要加以改进,以减少医源性肿瘤脱落种植风险。

Digital radiograph(DR)guided bedside IVC filter placements in patients with intracranial pressure monitors

Purpose:The purpose of this study is to report a single center experience with portable digital radiographically(DR)guided bedside IVC filters placed in intensive care unit(ICU)patients with high ICP and elevated head of bed(HOB).Materials and methods:A retrospective chart review was conducted on all bedside IVC filters placed from January 1,2010 to September 16,2020.Patients with high ICP and elevated head of bed requirements were included.Charts were reviewed for filter type,common femoral vein(CFV)access,filter location,pre procedure imaging,pre and post filter ICPs,glascow coma scale,number of radiographs taken,and filter removal.ICPs were obtained 1 h prior to procedure and 2 h post procedure and analyzed with a paired T test.Filters were placed by reviewing prior CT scan for IVC size,caval variants,renal and iliac veins and vertebral body landmarks.Then,CFV access was obtained and a Bentson wire was advanced 30-40 cm.A radiograph was used to confirm adequate position of the of the wire.The filter sheath was advanced and serial radiographs were used to position the filter sheath at the final predetermined position below the renal veins and above the iliac bifurcation.The filter was deployed,and a radiograph was obtained to confirm filter positioning.Results:A total of 9 DR guided bedside IVC filters were placed(4 Denali,3 Option Elite,2 Celect).Indications included prophylactic placement(n=8)and acute DVT(n=1).The average patient age was 35.8 years(range:18-56 years)CT abdomen and pelvis was used to assess for the level of renal veins in all patients(n=9).No caval variants were encountered on pre-procedural planning.The average pre,intraprocedural,and post procedure intracranial pressure was 16 mmHg,13 mmHg,and 16 mmHg,respectively.Confirmation of placement after final placement was available in 7 patients(4 DR,2 CT and one fluoroscopic examination).Two non-procedural related deaths occurred.Technical success,defined as successful placement of IVC filter at the predetermined level,was achieved in 100%of patients(n=9).The right CFV was used in most patients(n=7).The left CFV was used for access in two patients due to right CFV thrombus(n=1)and existing right femoral venous central line(n=1).The average number of radiographs taken was 5.8(range 4-9).In all cases,filters were placed below the level of the lowest renal vein(n=9).A comparison of pre,during and post intervention ICP pressures is shown in table,2.No differences between pre and post filter ICP was noted(p=0.77).Three filters were later removed.One minor complication was reported,which was filter tilt(23%)in an Option filter.Conclusion:Bedside IVC filters can be safely placed in patients with head trauma and high ICP who are unable to lay supine using portable DR guidance with a high rate of technical success and minimal complications.

Delayed Lumbar Artery Laceration and Symptomatic Retroperitoneal Hemorrhage Following IVC Filter Placement

Inferior vena cava filters are placed in selected patients to protect against potentially fatal pulmonary embolism. Generally, filter placement is regarded as a safe procedure although rare complications may arise. Recurrent thromboembolic events are the most common complications assoiated with inferior vena cava filters;however, there are multiple reports of filter fracture, migration, embolization, penetration and perforation. The aim of this report is to illustrate a serious potential complication of inferior vena cava filters. We report a rare case of symptomatic retroperitoneal hemorrhage occurring 3 weeks after filter placement treated successfully with selective arterial embolization of a lumbar artery laceration. This case serves to highlight the importance of retrieving filters when they are no longer beneficial.

Loop技术矫转法对复杂性下腔静脉滤器取出的技巧及应用效果分析

目的在临床实践过程中,我们发明了loop技术矫转法应用于复杂性下腔静脉滤器的取出,本文探讨该技术应用的技巧和优势。方法 回顾2022年1月至2022年12月于山西医科大学第二医院血管外科行下腔静脉滤器取出的417例患者的临床资料。以手术时间和术中辐射量为评判指标,比较标准滤器取出术、loop技术矫转法和loop配合其他技术的优劣。结果 Loop技术矫转法术中辐射剂量及手术时长均显著低于loop联合其他辅助技术(P<0.000 1)。结论 Loop技术矫转法对于复杂性下腔静脉滤器的取出,尤其是严重倾斜、回收钩贴壁的滤器,可缩短手术时间,降低手术辐射剂量,有较高的安全性和实用性,器械简单、可单人操作,利于开展,值得推广。

可调弯鞘在回收困难的伞形下腔静脉滤器取出术中的应用

目的探讨可调弯鞘在回收困难的伞形下腔静脉滤器取出术中的应用价值。方法收集2021年7月至2023年2月于南京中医药大学附属无锡医院就诊的24例滤器回收困难患者临床资料,均采用可调弯鞘进行滤器回收,分析所有患者的手术成功率,观察下腔静脉血流通畅情况、管壁情况、造影剂外溢或滞留情况、滤器情况、相关并发症发生情况。结果23例患者手术成功,1例因患有阿尔茨海默病,术中不能配合而放弃手术。回收滤器均结构完整、无折断,无变形,滤器取出后行下腔静脉造影均未发现造影剂滞留或外渗。手术时间25~120 min,平均58 min,未明显增加手术时间及费用,无相关并发症发生。结论应用可调弯鞘可以显著提高回收钩贴壁的下腔静脉滤器回收成功率,安全、有效,具有一定的临床应用价值。

下腔静脉滤器脱落移位至右髂外静脉1例

患者男,87岁,左下肢肿胀、疼痛1月余,加重并红肿4天;患慢性阻塞性肺疾病多年,具体不详。查体:左大腿内侧至小腿上段肿胀,皮肤潮红、皮温升高,波动感(+)。下肢静脉超声见左侧腘静脉至胫后静脉局部血栓形成。于左小腿抽出暗红色脓液,细菌涂片显示革兰氏阳性球菌(++)。

不同入路放置下腔静脉滤器的效果分析

目的 探讨经颈静脉和经股静脉不同入路置入下腔静脉滤器(Inferior vena cava filter,IVCF)的效果差异。方法 选取我院收治的股静脉穿刺置管后发生急性髂股静脉血栓形成且单纯行IVCF置入术后资料完整患者66例,按IVCF置入的不同入路将以上患者分为经颈静脉入路组和经股静脉入路组,比较两组在出血、IVCF倾斜、排尿困难、腰背疼痛、舒适度、满意度、睡眠质量等方面的效果差异。结果 经颈静脉入路组排尿困难发生率低于经股静脉入路组,差异有统计学意义(P<0.05)。经颈静脉入路组腰背疼痛评分和睡眠质量平均评分均低于经股静脉入路组,差异有统计学意义(P<0.05),舒适度、满意度评分均高于经股静脉入路组,差异有统计学意义(P<0.05)。结论 经颈静脉穿刺IVCF置入可以降低患者术后排尿困难以及腰背疼痛的情况发生,患者具有较高的舒适度、满意度以及睡眠质量。

CT后处理技术对下腔静脉滤器置入的术后评估

目的探讨CT后处理技术评估下腔静脉滤器置入后状态及相关并发症的价值。方法收集2014年1月-2022年1月在玉溪市人民医院置入可回收下腔静脉滤器的患者52例,均行CTV及滤器CT三维重建等后处理技术,评估下腔静脉滤器的位置、形态及有无并发症。结果52例患者滤器均未见主体或支脚断裂、下腔静脉狭窄。所有患者滤器位置正常,未见移位;36例患者滤器内未捕获血栓,16例患者滤器内捕获血栓。滤器脚穿透下腔静脉壁的程度为:0级14例,1级12例,2级26例。滤器发生轴向偏斜8例。结论CT后处理技术能清楚显示下腔静脉滤器的形态、位置及有无并发症情况,对下腔静脉滤器置入术后评估有一定临床价值。