Clinical application of the convertible vena cava filter / 中华普通外科杂志

Objective:To evaluate the short-term efficacy, safety and complications of convertible vena cava filter.Methods:The clinical and follow-up data of 103 patients who were placed with the convertible vena cava filter from May 2017 to May 2018 were retrospectively analyzed.Results:The convertible vena cava filters were successfully implanted in all cases. Twenty-seven cases underwent filter conversion, and 26 cases were successfully converted (5-145 days after implantation). None of them had complications such as thrombus formation, displacement, tilt, fracture or vein wall penetration. The reasons for no conversion included age (18.4%, 19/103), high-risk patients (12.6%, 13/103), limited organ function (9.7%, 10/103), etc. Ninety-four patients (91.3%) were followed up for 6 months. One developed thrombus in the filter, 3 developed lower limb venous thrombosis without inferior vena cava occlusion, and no patients were found with symptomatic pulmonary embolism.Conclusions:The convertible vena cava filter can safely and effectively reduce the incidence of perioperative pulmonary embolism.Age, limited organ function and high-risk of thrombosis are the main reasons for the low conversion rate.

Influência do sexo e da idade sobre o diâmetro da cava inferior e implicações para o implante de filtros de veia cava / Influence of sex and age on inferior vena cava diameter and implications for the implantation of vena cava filters

Resumo Contexto A aferição do diâmetro venoso e a escolha de um filtro de veia cava compatível são fundamentais para diminuir o risco de complicações decorrentes do implante desses dispositivos. Entretanto, são escassas as informações sobre como o diâmetro da cava inferior varia de acordo com o sexo e a idade. Objetivos Determinar a influência do sexo e da idade dos pacientes sobre o diâmetro da cava inferior e a adequação dos diferentes modelos de filtro disponíveis. Métodos Estudo analítico retrospectivo, realizado a partir de imagens de tomografia computadorizada. O diâmetro no segmento infrarrenal da veia cava inferior foi aferido em três pontos (cranial, médio e caudal). Os resultados foram classificados de acordo com o sexo e as faixas etárias. Resultados Foram analisadas tomografias de 417 pacientes: 245 mulheres e 172 homens. Os diâmetros nos pontos médio e caudal foram, respectivamente, 19,1 mm e 20,6 mm em mulheres de 81 a 92 anos, sendo estatisticamente menores (p < 0,05) quando comparados aos de mulheres com idade entre 19 e 40 anos (diâmetro no ponto médio: 22,7 mm; diâmetro no ponto caudal: 23 mm). Resultados semelhantes foram observados em homens. Os diâmetros venosos nos pontos cranial e caudal foram estatisticamente maiores em homens (ponto cranial: 24,4 mm; ponto caudal: 22,3 mm) do que em mulheres (ponto cranial: 22,6 mm; ponto caudal: 20,8 mm) em pacientes com idade entre 51 e 70 anos (p < 0,05). Conclusões O diâmetro da veia cava inferior foi menor em pacientes com idade mais avançada em ambos os sexos, e a taxa de variação do diâmetro foi semelhante entre homens e mulheres.

Abstract Background Measuring the venous diameter and choosing a compatible vena cava filter are essential to reduce the risk of complications resulting from implantation of these devices. However, there is little information on how the diameter of the inferior vena cava varies with sex and age. Objectives To determine the influence of patients' gender and age on their inferior vena cava diameter and the suitability of the different models of available filters. Methods Retrospective analytical study based on computed tomography images. The diameter of the inferior vena cava was measured at 3 points: above the confluence of the common iliac veins, below the renal veins, and midway between these two points (cranial point, caudal point, and midpoint) using Arya® and Carestream PACS® software. The results were classified by sex and age groups. Results CT scans of 417 patients were analyzed: 245 women and 172 men. The diameters at the midpoint and caudal point were, respectively, 19.1 mm and 20.6 mm in women from 81 to 92 years old and were statistically smaller (p< 0.05) when compared to women aged 19 to 40 years (midpoint: 22.7 mm; caudal point: 23 mm). Similar results were seen in men. Venous diameters at the cranial and caudal points in patients aged from 51 to 70 years were statistically larger in men (cranial point: 24.4 mm; caudal point:22.3 mm) than in women (cranial point: 22.6 mm; caudal point:20.8 mm) (p< 0.05). Conclusions A smaller diameter was found for the inferior vena cava in older patients of both sexes and the rate of diameter change was similar among men and women.

Temporal trends in vena cava filter implantation in public health system inpatients: an 11-year analysis of the largest city in Brazil / Tendência temporal do implante de filtro de veia cava em pacientes internados no SUS em São Paulo: análise de 11 anos da maior cidade do Brasil

Abstract Background Vena cava filter implantation is considered a simple procedure, which can lead to overuse and over-indication. It is nevertheless associated with short and long-term complications. Objectives The goals of this study were to evaluate rates of vena cava filter implantation conducted by Brazil's Unified Public Health System, analyzing in-hospital mortality and migration of patients from other cities seeking medical attention in São Paulo. Methods This study analyzed all vena cava filter procedures conducted from 2008 to 2018 in the city of São Paulo and registered on the public database using a big data system to conduct web scraping of publicly available databases. Results A total of 1324 vena cava filter implantations were analyzed. 60.5% of the patients were female; 61.7% were under 65 years old; 34.07% had registered addresses in other cities or states; and there was a 7.4% in-hospital mortality rate. Conclusions We observed an increase in the rates of use of vena cava filters up to 2010 and a decrease in rates from that year onwards, which coincides with the year that the Food and Drug Administration published a recommendation to better evaluate vena cava filter indications.

Resumo Contexto O implante de filtro de veia cava é considerado um procedimento de baixa complexidade, o que pode resultar em indicação excessiva. No entanto, não é isento de complicações a curto e longo prazo. Objetivos Avaliar as taxas de implantes de filtro de veia cava realizados pelo Sistema Único de Saúde e a origem geográfica e mortalidade intra-hospitalar dos pacientes. Métodos Foi conduzida uma análise em um banco de dados públicos referente às taxas de implantes de filtro de veia cava realizados de 2008 a 2018 na cidade de São Paulo, utilizando o sistema de big data. Resultados Foram analisados 1.324 implantes de filtro de veia cava financiados pelo Sistema Único de Saúde. Identificou-se tendência de aumento da taxa de implantação até 2010 e de redução dos números após esse período. Do total de pacientes, 60,5% eram do sexo feminino; 61,75% tinham menos de 65 anos; e 34,07% possuíam endereço oficial em outra cidade ou estado. A taxa de mortalidade intra-hospitalar foi de 7,4%. Conclusões Observamos aumento das taxas de implante de filtro de veia cava até 2010 e redução das taxas após esse período, o que coincide com o ano em que a organização norte-americana Food and Drug Administration publicou uma recomendação para melhor avaliar as indicações de filtros.

Filtro de vena cava inferior, resultados a mediano y largo plazo / Inferior vena cava filter medium to long-term results

Resumen Introducción: El tromboembolismo pulmonar sin tratamiento, presenta un riesgo de recurrencia del 20%, con una mortalidad del 18% al 26%, en pacientes con embolia pulmonar donde esta contraindica o fracasa la anticoagulación, es necesario interrumpir parcialmente la vena cava inferior, siendo los filtros de vena cava la alternativa más utilizada. Objetivo: Analizar las variables epidemiológicas involucradas en la enfermedad tromboembólica y los resultados de la inserción del filtro de vena cava inferior. Materiales y Método: Estudio retrospectivo, observacional y descriptivo, donde se analiza la inserción sucesiva de 82 filtros de vena cava inferior, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo femenino 53,6%, edad promedio 60,4 años (rango 19-86), la principal causa para desarrollar enfermedad tromboembólica fueron las enfermedades oncológicas (56,09%), la principal vía de acceso fue la vena femoral común (69,51%), localización del filtro suprarrenal (4,87%), se obtuvo un seguimiento actualizado en el 89,02%, la supervivencia a 5 años fue de 73,17% y a 10 años de 57,32%, morbilidad en relación al procedimiento (9,75%), éxito del procedimiento (97,5%), no hubo mortalidad relacionada. Discusión: Los grandes ensayos, demuestran el beneficio de la interrupción de la vena cava inferior mediante filtros, especialmente en pacientes oncológicos, con elevado riesgo de embolia pulmonar. Conclusión: La inserción de un filtro de vena cava inferior, adecuadamente indicado, es un procedimiento mínimamente invasivo, de bajo riesgo y con excelentes resultados en la profilaxis de la embolia pulmonar.

Introduction: Pulmonary thromboembolism without treatment presents a risk of recurrence of 20%, with a mortality of 18% to 26%. In patients with pulmonary embolism, when anticoagulation therapy is contraindicated or failed, it is necessary to intervene partially the inferior vena cava on which cava vein filters are the main used alternative. Aim: Analyze the epidemiological variables involved on thromboembolic disease, and the outcomes of the inferior vena cava filter insertions. Materials and Method: Retrospective, observational and descriptive study, which analyzes the successive insertion of 82 inferior vena cava filters, over a period of 10 years (2009 to 2019), in the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Female sex 53.6%, average age 60.4 years (range 19-86), the main cause to develop thromboembolic disease were oncological diseases (56.09%); the main access path was the common femoral vein (69.51%); in a 4.87% the location of the filter was suprarenal. Complete follow-up was obtained in 89.02% of the cases, 5-year survival with 73.17% ratio and 10-years survival of 57.32%, morbidity in relation to the procedure was 9.75%; success of the procedure 97.5%; there was no mortality related. Discussion: Large studies demonstrate the benefits of interruption on the inferior vena cava through filters, especially in cancer patients with high risk of pulmonary embolism. Conclusion: The insertion of an inferior vena cava filter when indication is adequate, is a minimally invasive procedure with low risk and excellent results in the prophylaxis of pulmonary embolism.

An alternative approach to treatment of inferior vena cava filter perforation / Tratamento alternativo para perfuração de veia cava inferior por filtro

Abstract We report a case of inferior vena cava filter perforation immediately after filter implantation, recognized intraoperatively in a patient undergoing laparotomy for resection of locally advanced ovarian cancer. We describe an alternative approach with strut resection, less invasive than filter removal, enabling the device to be maintained and bleeding to be controlled.

Resumo Relatamos um caso de perfuração de veia cava inferior imediatamente após o implante de um filtro. A complicação foi reconhecida no intraoperatório de uma laparotomia para ressecção de um câncer de ovário localmente avançado. Descrevemos uma abordagem alternativa, menos invasiva do que a remoção do filtro, consistindo na ressecção das hastes do dispositivo. Essa abordagem permitiu a manutenção do filtro e o controle efetivo do sangramento.

Effect of different structural parameters of filter rod on mechanical properties of new vena cava filter / 生物医学工程学杂志

The dynamic analysis of the implantation process of a new vena cava filter was carried out by finite element analysis method to reveal the influence of the angle, length, width and thickness of the filter rod on its mechanical properties and the inner wall of the blood vessel. The results showed that the high-stress and high-strain areas of the filter were mainly concentrated in the connection between the filter rod and the filter wire. With the increase of the angle of the filter rod, the maximum equivalent stress and the maximum elastic strain on the filter wall decreased, while the maximum equivalent stress on the vascular wall increased. With the increase of the length of the filter rod, the maximum equivalent stress and strain peak of the filter wall increased, but the maximum equivalent stress of the vessel wall decreased. With the increase of the width and thickness of the filter rod, the maximum equivalent stress of the filter wall, the maximum elastic strain and the maximum equivalent stress of the vessel wall all showed an upward trend. The static safety factor of all filter models was greater than 1, and the structure after implantation was safe and reliable. The results of this study are expected to provide a theoretical basis for the structural optimization and deformation mechanism of the new type vena cava filter.

Inferior vena cava filter removal – Hope for the best and prepare for the worst: An anesthesiology perspective

A patient presented to our institution for an elective removal of an inferior vena cava (IVC) filter under local anesthesia. Once removed, it was noticed that the filter had a missing secondary leg. The patient had a chest CT done which showed a hyper-attenuating structure in the region of the tricuspid valve highly suspicious for the fractured strut of the filter. Upon these findings, the patient was taken once again to the surgical suite for an endovascular retrieval of the strut. For fear of a possible cardiac injury and a potential need for a sternotomy, the patient received general anesthesia and was placed with appropriate IV access and full cardiac monitors. The strut was removed successfully without any complications. Despite the relative benign nature of this endovascular procedure, one should always be prepared for an appropriate resuscitation in case of an occurrence of a surgical complication.

Surgical Removal of the Inferior Vena Cava Filter Using Minimal Cavotomy: A Case Report

The use of retrievable inferior vena cava (IVC) filters has markedly increased in the recent years. However, the failure rate for the retrieval of the IVC filters using the endovascular method is reported to be up to 19%. Open surgical removal of the IVC filters is technically challenging and may require longitudinal cavotomy, clamping, and repair of the IVC. Here, we present a case of successful open surgical removal of the IVC filter using minimal cavotomy. This technique is an effective method after a failed endovascular removal attempt.

Application Status and Biomechanical Research Progress of Vena Cava Filter / 医用生物力学

Vena cava filter was widely used in clinic to prevent pulmonary embolism in treating lower extremity deep venous thrombosis（DVT）. In this paper, application status of vena cava filter was reviewed, including the way of vena cava filter implantation, filter classification, indications of filter implantation and existing problems (contraindications and complications). The frontier issues concerning study on novel filters, such as the degradation filter and drug coated filter was also analyzed, and the hemodynamic research progress from domestic scholars in recent years about filter structure was briefly summarized. The research findings provide references for further optimization of filter structure and clinical application of vena cava filter.

An experimental study on a new type of biodegradable vena cava filter / 中华普通外科杂志

Objective To evaluate a new biodegradable inferior vena cava(IVC) filter by in vitro and in vivo experiments.Methods The biodegradable filter consisted of metal stent and absorbable suture,which acts as a degradable deformable switch of the filter.When the suture of the proximal metal filter degrades and lost its tension,the metal filter will change into a stent.In vitro experiments were performed to test the influence of the sterilization method and the tension of absorbable sutures to the filter's selfconvertible time,animal experiments were conducted to evaluate the effectiveness of emboli capture and to observe the in vivo self-convertible time of the filter.IVC stenosis,pulmonary embolus and intimal hyperplasia and inflammation were evaluated.Results Ethylene oxide sterilization did not have an adverse effect on the self-convertible time of the filters.The tension did not affect the degradation rates of the suture significantly.In animal experiments,the VCFs were successfully implanted via femoral vein approach.Not any tilt,migration or structural damage of the filters was found during the follow-up time.Postoperative fluoroscopy and autopsy confirmed that there was no stenosis or thrombosis,IVC perforation.After implantation large thrombi were captured.The sutures degraded and filters transformed into stents in 3 weeks.After 90 days IVC was patent with mild intimal hyperplasia and no thrombosis.Conclusions This study demonstrated the effectiveness and safety of the biodegradable filter we designed.

Clinical Outcomes of a Preoperative Inferior Vena Cava Filter in Acute Venous Thromboembolism Patients Undergoing Abdominal-Pelvic Cancer or Orthopedic Surgery

PURPOSE: Surgery is the most common risk factor for pulmonary embolism (PE) in patients with a recent venous thromboembolism (VTE). This study reviewed clinical outcomes of preoperative inferior vena cava filter (IVCF) use in patients with acute VTE during abdominal-pelvic cancer or lower extremity orthopedic surgeries. MATERIALS AND METHODS: We retrospectively analyzed 122 patients with a recent VTE who underwent IVCF replacement prior to abdominal-pelvic cancer or lower extremity orthopedic surgery conducted between January 2010 and December 2016. Demographics, clinical characteristics, postoperative IVCF status, risk factors for a captured thrombus, and clinical outcomes were collected for these subjects. RESULTS: Among the 122 study patients who were diagnosed with acute VTE in the prior 3 months and underwent preoperative IVCF replacement, 70 patients (57.4%) received abdominal-pelvic cancer surgery and 52 (42.6%) underwent lower extremity orthopedic surgery. There were no perioperative complications associated with IVCF in the study population and no cases of symptomatic PE postoperatively. A captured thrombus in the filter was identified postoperatively in 16 patients (13.1%). Logistic regression analysis indicated that postoperative anticoagulation within 48 hours significantly reduced the risk of a captured thrombus (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08–0.94; P=0.032). CONCLUSION: A captured thrombus in preoperative IVCF was identified postoperatively in 16 patients (13.1%). Postoperative anticoagulation within 48 hours reduces the risk of captured thrombus in these cases.

The recyclability and safety of Celect retrievable vena cava filter / 中华放射学杂志

Objective To explore the recyclability and safety of Celect retrievable filter placement in the prevention of pulmonary embolism in patients with deep venous thrombosis(DVT).Methods The data of 120 DVT patients with Celect retrievable filter were collected from the Second Hospital of Shanxi Medical University from August 2015 to March 2017 and analyzed retrospectively. The Celect filter was placed in the inferior vena cava(IVC)at the inferior margin of the renal vein for 1 to 2 cm by puncturing the contralateral femoral vein or right internal jugular vein.The filter retrieve risk was assessed within 8 weeks after being implanted. The filters would be recovered through the right jugular vein when meeting the recovery standard, and the retrieve methods included conventional method, removing the guide wire into a loop trap method and guiding wire into a loop combined with balloon assisted method.The perforation of the vena cava was observed and the tilt angle of the filter was measured.The success rate of Celect filter retrieve was evaluated by the Kaplan-Meier method. Results Celect filters were successfully implanted in 120 patients with DVT.The IVC filters were implanted through femoral vein in 111 patients and 2 cases via right internal jugular vein.No complications,asymptomatic pulmonary embolism and related death was found in all patients.Twenty four patients did not reach the standard of filter retrieve,and were follow-uped.Ninety six cases were treated with Celect retrievable filter,among which,93 cases were successfully recovered with the filter indwelling time ranging from 7 to 144 days and the median being 50 days.The failure of the filter retrieve occurred in 3 cases because of the serious tilt of the filter or the encapsulation of filter by inferior vena cava thrombus.Perforation of vena cava with no clinical symptoms occurred in 21 cases.Filter tilt was found in 35 cases,among which,15 cases had inclined angle>15 degrees or the recovery hook closed to the IVC wall.Thirteen cases with filter tip or recovery hook attached to the wall were successfully removed by using the guide wire into a loop or trap guide wire into a loop combined with balloon assisted method instead of routine removal method.The retrieve rate was 100% when the retention time of Celect filter in the body was within 106 days. Conclusion Celect retrievable filter can be implanted in DVT patients with long retrieve time window and high retrieve rate,but the filter inclination rate and vena cava perforation rate are high.

Application of bedside color Doppler ultrasound-guided popliteal vein catheter thrombolytic therapy in treatment of lower extremity deep venous thrombosis / 中国介入影像与治疗学

Objective To evaluate the feasibility of beside color Doppler ultrasound-guided popliteal vein catheter in treatment of lower extremity deep venous thrombosis (LEDVT).Methods Data of 50 patients with unilateral LEDVT were reviewed,including 25 cases underwent beside color Doppler ultrasound-guided catheter thrombolytic therapy (catheter thrombolytic group) and 25 cases underwent systemic thrombolysis and anticoagulant therapy (anticoagulant thrombolysis group).The cure rate,hospitalization time and the bilateral diameter differences were compared between the 2 groups.Results Thrombolytic effective rate was 100％ in both the 2 groups.Thirty patients were clinical cured,including 22 cases in catheter thrombolytic group and 8 cases in anticoagulant thrombolysis group.The cure rates were significantly different between the 2 groups (88.00％ [22/25] vs 32.00％ [8/25],x2 =16.333,P＜ 0.001).The hospitalization time of catheter thrombolytic group ([12.32 ± 1.49] days) was shorter than that of anticoagulant thrombolysis group ([16.44±2.95]days;t=-6.426,P＜0.001).The diameter differences between LEDVT side and contralateral side of the upper and lower 15 cm form knees in catheter thrombolytic group showed no statistical difference compared with anticoagulant thrombolysis group before the treatment (both P＞0.05),while of catheter thrombolytic group were smaller than those of anticoagulant thrombolysis group after the treatment (both P＜0.05).And the bilateral diameter differences before the treatment were larger than those after the treatment in both groups (all P ＜ 0.05).Conclusion Both of beside color Doppler ultrasound-guided catheter thrombolytic therapy and systemic thrombolysis and anticoagulant therapy can be used to treat LEDVT,while the efficacy of ultrasound-guided catheter thrombolytic therapy is better.

Influencing factors for venous patency rate in patients with deep venous thrombosis of lower limbs treated with inferior vena cava filter combined with catheter-directed thrombolysis / 新乡医学院学报

Objective To investigate the influencing factors for venous patency rate in patients with deep venous thrombosis(DVT) of lower limbs treated with inferior vena cava filter(IVCF) combined with catheter-directed thrombolysis.Methods A total of 120 patients with DVT of lower limbs who underwent IVCF combined with catheter-directed thrombolysis were selected from March 2014 to March 2017 in Zhumadian Central Hospital.The patients were divided into poor effect group (patency rate ＜ 50％) and good effect group (patency rate ≥ 50％) according to venous patency rate after treatment.The clinical data were compared between the two groups.The influencing factors for venous patency rate in patients with DVT of lower limbs after IVCF placement and catheter-directed thrombolysis were analyzed by logistic regression.Results Among the 120 pauems with DVT of lower limbs,the venous patency rate was less than 50％ in 62 cases (poor effect group),and the venous patency rate was equal to or greater than 50％ in 58 cases (good effect group).The proportion of patients with high blood pressure,diabetes mellitus and malignant tumor in good effect group was significantly lower than that in poor effect group (P ＜0.05);there was a significant difference in DVT staging and location between the two groups (P ＜ 0.05);the levels of platelet count,white blood cell count and plasma fibrinogen in good effect group were significantly lower than those in poor effect group (P ＜ 0.05).There was no significant difference in sex,age,operation history,trauma history and D-dimer level between the two groups (P ＞ 0.05).Multivariate logistic regression analysis showed that white blood cell count,plasma fibrinogen,DVT staging and location were the influencing factors for venous patency rate after IVCF placement and catheter-directed thrombolysis in patients with DVT of lower limbs (P ＜ 0.05);but hypertension,diabetes mellitus,malignant tumor and platelet count were not related to the venous patency rate (P ＞ 0.05).Conclusion White blood cell count,plasma fibrinogen,DVT staging and location are the influencing factors for venous patency rate after IVCF placement and catheter-directed thrombolysis in patients with DVT of lower limbs.Relevant measures should be formulated in order to improve the treatment effectiveness.

A Case Report of Successful Surgical Treatment of Removing an Inferior Vena Cava Filter / 日本心臓血管外科学会雑誌

Acute pulmonary embolism (PE), usually secondary to deep venous thrombosis (DVT), is a serious disease which may cause sudden death. An inferior vena cava filter (IVCF) is placed in certain circumstances to prevent recurrence of PE. However, some complications of IVCF have been reported and the indications of IVCF should be reviewed. We encounted a case of IVCF migration which required surgical removal through right intercostal thoracotomy. The patient was a 53-year-old woman. She had undergone the placement of IVCF for DVT followed by anticoagulant therapy. Eight days after, CT revealed IVCF migrated above renal veins. As percutaneous extraction was attempted unsuccessfully, the direct approach to remove IVCF between the hepatic vein and renal vein was indicated. Through the right side thoracotomy at the seventh intercostal space with the division of costal arch, the inferior vena cava (IVC) was exposed near the right atrium. The diaphragm was longitudinally divided straight to IVC and the liver was retraced anteriorly after the careful dissection of the venous plexus on the back of the liver. IVCF could be palpated and just below the branch of the caudate rami and above the right renal vein. After systemic heparinization, IVC and branches were clamped simply and IVC was incised longitudinally. The proximal tip of the IVCF dug into the intima and the distal hook penetrated the vein. IVCF was carefully removed and incision and penetration of IVC were repaired. Her postoperative course was unremarkable, and the patient was discharged without any complications.

Clinical curative effect analysis of vena cava filter placement and thrombolytic therapy combined with Rivaroxaban for acute deep venous thrombosis / 实用放射学杂志

Objective To analyze the clinical curative effect of inferior vena cava filter placement and catheter direct thrombolytic therapy combined with anticoagulant therapy with Rivaroxaban for deep venous thrombus (DVT) of the lower extremity.Methods 40 patients with acute lower extremity DVT were collected,after the inferior vena cava filter placement,thrombolytic catheter were placed in femoral and iliac vein occlusion,and urokinase was continuously infused through the catheter 24 h.Anticoagulant therapy with Rivaroxaban tablets started when the patient was diagnosed with the disease.We evaluated the short-term and long-term efficacy of the treatment from the iliac femoral vein patency,limb circumference and complications.Results 40 patients were successfully implanted the filter,38 patients were successfully removed the filter after 21 days.The clinical symptoms were relieved after 7 days of treatment,and the iliac femoral vein blood flow was basically recovered.Before and after treatment,the limb circumference was significantly reduced (P＜0.05).No serious complications occurred during the treatment period.Following up in 6 months,the rate of iliac vein occlusion and pigmentation were 2.5 ％ (1/40)and 2.5 ％ (1/40)respectively.Following up in 12 months,the rate of iliac vein occlusion and pigmentation were 7.5 ％ (3/40) and 5.0 ％ (2/40)respectively.Conclusion For treatment of acute DVT of the lower extremity,inferior vena cava filter placement and catheter direct thrombolytic therapy combined with anticoagulant therapy with Rivaroxaban can achieve satisfactory clinical curative effect,which is clinically safe and feasible.

Should We Remove the Retrievable Cook Celect Inferior Vena Cava Filter? Eight Years of Experience at a Single Center

BACKGROUND: The inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications. METHODS: A retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated. RESULTS: The most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004). CONCLUSION: If the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.

Role of hybrid operating room in surgery for the right atrial thrombus, pulmonary thrombi, and ventricular septal rupture after myocardial infarction.

Free‑floating right heart thrombi are uncommon and need emergency treatment in view of their tendency to dislodge and cause pulmonary embolism. We report a successful surgical management of a patient who had large mobile right atrial thrombus, bilateral pulmonary thrombi, coronary artery disease, and postmyocardial infarction ventricular septal rupture (VSR). The patient underwent coronary angiography, inferior vena cava filter placement, removal of thrombi from the right atrium and pulmonary arteries, repair of VSR, and coronary artery bypass graft surgery in a hybrid operating room.

In vivo evaluation of a new vena cava filter / Avaliação in vivo de um novo filtro de veia cava

Background Pulmonary embolism is an important cause of cardiovascular death. Inferior vena cava filters have been shown to be effective for prevention of this condition. Objectives To determine the safety, performance and efficacy of a new inferior vena cava filter in an ovine model. Methods BKone1 filters are self-centering with over-the-wire deployment, have three filtering regions and are made from nickel-titanium alloy. Eight of these filters were implanted in 8 sheep. The sheep were divided into 4 groups of two animals (A and B) and the number of clots injected differed by group. Two clots were injected in group 2, four in group 3, eight in group 4 and zero clots in group 1. A animals underwent euthanasia soon after the procedure and B animals were observed for 30 days and then euthanized after a control cavography. All inferior vena cavas were processed for histological examination. Clots were prepared in a metal mold, sectioned and then radiopaque markers were inserted. Clot capture was analyzed by identifying the radiopaque marker on fluoroscopy. Results No clot migration was observed during follow-up. Control cavographies showed patent inferior vena cavas. Pathological examination indicated little inflammatory tissue response. All clots were captured in the condition with 2 clots, only one clot was missed in the group injected with 4 clots and in the condition of 8 clots, they were partly captured. Conclusions The filters were deployed safely. There was a reduction in efficacy as the number of blood clots increased.

Contexto Embolia pulmonar é uma importante causa de morte cardiovascular. Filtros de veia cava inferior têm se mostrado efetivos na sua prevenção. Objetivos Determinar a segurança, o desempenho e a eficácia de um novo filtro de veia cava inferior em estudo experimental utilizando modelos ovinos. Métodos Filtros BKone1 são autocentrantes, over-the-wire (OTW), compostos por três regiões de filtragem e construídos em liga de níquel-titânio. Oito filtros foram implantados em oito ovelhas. As ovelhas foram divididas em quatro grupos, de acordo com o número de êmbolos injetados, com dois animais em cada grupo (A e B). Foram injetados dois êmbolos no grupo 2, quatro no grupo 3, oito no grupo 4 e nenhum êmbolo no grupo 1. Os animais denominados A foram submetidos a eutanásia logo após o procedimento e os animais B foram observados por 30 dias, sendo submetidos a eutanásia após a realização de uma cavografia de controle. Após a eutanásia, todos os animais foram submetidos a explante do segmento de veia cava inferior contendo o filtro para análise anatomopatológica. Os êmbolos foram preparados em molde metálico e seccionados, adicionando-se marcadores radiopacos. A retenção dos êmbolos foi constatada através da identificação da marca radiopaca na seção de captura do filtro, via fluoroscopia. Resultados Não foi observada migração do filtro após o período de 30 dias. As cavografias de controle mostraram perviedade das veias cava inferior. Os resultados dos exames anatomopatológicos indicaram pouca resposta inflamatória dos tecidos. Os êmbolos foram capturados totalmente na condição com dois êmbolos, apenas um êmbolo não foi capturado no grupo com quatro êmbolos e na condição de oito êmbolos, eles foram parcialmente capturados. Conclusões Os filtros foram entregues com segurança. Há uma queda na eficácia de captura com o aumento da quantidade de êmbolos.

Uso de cânula venovenosa com duplo-lúmen para oxigenação por membrana extracorpórea em paciente com síndrome de angústia respiratória aguda com prévia inserção de filtro na veia cava inferior: relato de caso / Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report

RESUMO A oxigenação por membrana extracorpórea é utilizada em casos de hipoxemia refratária em diversas condições clínicas. Pacientes vítimas de traumatismo torácico geralmente desenvolvem síndrome da angústia respiratória aguda. Em razão do elevado risco de sangramentos, as complicações trombóticas que se apresentam neste contexto são particularmente difíceis de tratar e, geralmente, demandam a inserção de um filtro na veia cava inferior, com a finalidade de prevenir a migração de êmbolos oriundos das veias distais para a circulação pulmonar. Neste artigo, apresentamos o caso de um paciente com traumatismo torácico, que apresentou grave síndrome de angústia respiratória aguda, com necessidade de utilizar oxigenação por membrana extracorpórea aplicada por meio da introdução de uma cânula com duplo-lúmen na veia jugular interna direita. Este procedimento foi realizado tendo em vista a prévia inserção de um filtro na veia cava inferior, por conta da ocorrência de trombose venosa profunda em ambas as panturrilhas.

ABSTRACT Extracorporeal membrane oxygenation is used in refractory hypoxemia in many clinical settings. Thoracic trauma patients usually develop acute respiratory distress syndrome. Due to high risk of bleeding, thrombotic complications present in this context are particularly difficult to manage and usually require insertion of an inferior vena cava filter to prevent embolism from the distal veins to the pulmonary circulation. Here, we present a case of a thoracic trauma patient with severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation via a right internal jugular double lumen cannula due to a previously inserted inferior vena cava filter caused by distal bilateral calf muscle vein deep vein thrombosis.