Trapping of Massive Thrombus in an Inferior Vena Cava Filter: Treatment with Additional Filter Placement and Aspiration Thrombectomy

For the patients suffering from extensive deep vein thrombosis (DVT), the placement of an inferior vena cava (IVC) filter in conjunction with anticoagulant therapy has been used to prevent pulmonary embolisms. However, for the patients who anticoagulant is contraindicated or if this is complicated, the use of an IVC filter without concurrent anticoagulation may become the sole treatment for pulmonary embolisms. In this situation, the thrombi trapped in the IVC filter may cause significant clinical problems. We report here on a case of IVC filter thrombosis that was successfully treated by aspiration thrombectomy after placing another filter proximal to the previous filter.

Titanium Greenfield Inferior Vena Cava Filter: Effectiveness of Percutaneous Placement for Prevention of Pulmonary Embolism

PURPOSE: To evaluate the effectiveness of percutaneous placement of a Greenfield titanium filter in the inferior vena cava (IVC) for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT). MATERIALS AND METHODS: Twelve patients with DVT underwent percutaneous Greenfield titanium filter placement. The indications included recurrent pulmonary embolism or failed anticoagulation therapy in six patients, extensive PE in three, and prophylaxis for high risk of PE in the remaining three. In all cases the filter was positioned after confirming the anatomy, patency, and presence of thrombosis of the IVC and renal veins by inferior vena cavography. Long-term follow-up study involved clinical evaluation, plain radiography, Doppler ultrasonography and CT scanning. RESULT: Filter placement [infrarenal in ten patients (83%) and suprarenal in two (17%)] was technically successful in all cases (100%). The venous approach involved the right femoral vein in eight patients (67%) and the right internal jugular vein in four (33%). Complications included overlapping of the filter legs in three patients (25%), and misplacement in one (8%). After filter placement, no further PE developed. In all of five patients followed up for two years, the IVC maintained patency without evidence of caval perforation or occlusion. CONCLUSION: In patients with DVT, percutaneous placement of a Greenfield titanium filter is a safe and effective method for the prevention of PE.

Percutaneous Placement of Bird's Nest Inferior Vena Cava Filter

PURPOSE: To describe clinical experiences of the use of Bird's Nest inferior vena cava(IVC) filter. MATERIALS AND METHODS: Between August 1991 and August 1997, IVC filter was percutaneously inserted in 51 patientswith pulmonary embolism(PE) and deep vein thrombosis of the lower extremities. Indications for the placement ofthis filter were contraindication to anticoagulation in 17 patients, prophylaxis of PE in 17, failedanticoagulation in 11, massive PE with residual floating thrombus in three and complications involvinganticoagulation in 3. In order to delineate the location of renal vein and extension of deep vein thrombosis intothe IVC, all patients under went inferior vena cavography before filter placement. Thirty filters were insertedthrough the right femoral vein, 19 through the right internal jugular vein and three through the left femoralvein. The patients involved were followed up for periods ranging from one week to six years (mean, 10 months). RESULTS: A Bird's Nest IVC filter was placed in the infrarenal IVC in 44 patients and in the suprarenal IVC in7. Certain complicatioins ensued. IVC penetration occurred in three patients(5.9%), and in seven(1.37%) the filterwire prolapsed. Except for transient pain, however, there were no serious IVC penetration-related complicationsand no evidence of recurrence of PE in the cases involving prolapse of the filter wire. During follow up,clinically suspected recurrent PE was noted in two patients(3.9%), but there was no evidence of newly developedocclusion of the IVC. CONCLUSION: In patients who under went follow up, Bird's Nest IVC filter effectivelyprevented the development and recurrence of PE, and there were no complications. To prevent of penetration of theIVC and prolapse of the filter, however, technical skill was needed.

Percutaneous Insertion of Inferior Vena Cava Filter: Clinical Results of 8 patients

PURPOSE: To evaluate the efficacy and clinical results of percutaneous insertion of inferior vena cava(IVC) filter. MATERIALS AND METHODS: Over a two year period, eight IVC filters were placed in eight patients with pulmonary thromboembolism resulting from deep vein thrombosis of the legs. The indications for placement were contraindication to anticoagulation(3), and recurrent pulmonary embolism during anticoagulant therapy(5). Both femoral(7) and jugular(1) routes were used for percutaneous transvenous insertion. To delineate the caval anatomy and to ensure placement just caudal to the renal vein, a cavogram was obtained before filter placement. Bird's Nest (7) and Greenfield (1) filters were inserted. Follow-up information was obtained by means of duplex sonography, CT scan, abdominal radiograph, and perfusion scan of the lungs, followed by clinical evaluation. RESULTS: In all cases, procedures were technically successful. Placement complications occurred in three patients. In one, the filter was inadvertently placed above the iliac bifurcation; in the other two, prolapse of the Bird's Nest filter wire occurred. Occlusion of IVC occurred in two patients, and recurrent pulmonary embolism was suspected in one, who suffered from chest pain and shortness of breath. In the other patients, there was no clinical evidence of recurrence of the pulmonary embolism. CONCLUSION: Insertion of an inferior vena cava filteris a safe and effective method for the prevention of pulmonary embolism when anticoagulant therapy is either ineffective or contraindicated.