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.

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.

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.

Clinical study of domestic ZQL-type retrievable vena cava filter

Background Pulmonary thromboembolism （PTE） is a serious disease often leading to disability and death. Percutaneous placement of an inferior vena cava （IVC） filter is an effective method to prevent fatal PTE caused by lower extremity deep venous thrombosis （LEDVT）. We developed the ZQL-type retrievable vena cava filter. The aim of this study was to evaluate the safety and effectiveness of the ZQL-type filter for prevention of fatal PTE. Methods A total of 144 patients with indications for placement of an IVC filter received insertion of filters via a femoral （n=37） or jugular （n=107） vein approach. Abdominal X-ray and color Doppler ultrasonography of IVC were regularly performed to visualize the position and condition of the IVC filter following filter placement. If thrombi in the lower extremity deep veins were removed within 2 weeks, the filter retrieval procedure was performed after an abdominal radiograph, an inferior vena cavogram and a pulmonary angiography. Otherwise, the filter should be kept permanently in place with regular follow-up inspections. Results One hundred and forty-four filters were implanted at the target sites with a success rate of 98.61% for one-time placement and 100% for two-time placement. Of the 137 patients followed up （follow-up rate, 95.14%）, 43 patients had filters retrieved during a period of between 7 and 14 days （median, 12 days） following filter placement. The remaining 94 patients were followed for 7 days to 39 months （median follow-up period, 17 months）. No filter migration or tilt, filter fracture or IVC perforation was observed. No obstruction of IVC occurred. No symptomatic PTE developed during the follow-up period. Conclusion The ZQL-type retrievable vena cava filter is a safe and effective device to prevent PTE. This filter possesses a distinctive stent-shape, stable design, high capture efficacy, and is easy to insert and retrieve and thus is suitable for clinical application. Chin Med J 2009; 122（2）： 140-144

Prevention of tumor emboli from the inferior vena cava by the Tempofilter II during resection of nephroblastoma with level III tumor thrombus

The optimal treatment for patients with nephroblastoma and inferior vena cava （IVC） minor thrombus is radical nephrectomy and minor thrombectomv, but the operation for patients with level III tumor thrombus is usually at high risk of puhnonary, embolism （PE）. We report one case of nephroblastoma with level III thrombus in our hospital in 2007, the vena cava tumor thrombectonly was safely performed under the protection of Tempofilter II inferior vena cava filter.

Radiopaque nano and polymeric materials for atherosclerosis imaging, embolization and other catheterization procedures

A review of radiopaque nano and polymeric materials for atherosclerosis imaging and catheterization procedures is presented in this paper. Cardiovascular diseases(CVDs) are the leading cause of death in the US with atherosclerosis as a significant contributor for mortality and morbidity. In this review paper, we discussed the physics of radiopacity and X-ray/CT, clinically used contrast agents,and the recent progress in the development of radiopaque imaging agents and devices for the diagnosis and treatment of CVDs. We focused on radiopaque imaging agents for atherosclerosis, radiopaque embolic agents and drug eluting beads, and other radiopaque medical devices related to catheterization procedures to treat CVDs. Common strategies of introducing radiopacity in the polymers, together with examples of their applications in imaging and medical devices, are also presented.