Surgical Management of Perforated Inferior Vena Cava Filters.

Management of complicated indwelling inferior vena cava (IVC) filters has increased due to low retrieval rates. Filter migration and perforation are infrequent complications and require explantation of the filter. We report our recent experience with endovascular retrieval and surgical explantation of IVC filters after caval perforation. This is a retrospective review of patients who had IVC filter explantation between 2014 and 2015. Patient demographics, indication for filter placement, clinical presentation, surgical indication and technique, and outcomes were noted. Five cases of IVC filter removal due to caval perforation were identified. Four patients were female, and the median age was 50. Four IVC filters were of the retrievable type and had an average indwelling time of 4 years. One filter was permanent with an indwelling time of 9 years. The most common presentation was abdominal pain. Four patients had an open operation: 2 performed via laparotomy and 2 with retroperitoneal exposure of the IVC. One patient required median sternotomy and explantation of device fragments that migrated to the right ventricle. One patient had endovascular retrieval, with filter indwelling time of 0.8 years. No mortality occurred related to device removal. All patients had resolution of pain at their postoperative visit. Patients presenting with abdominal pain and history of IVC filter placement should cause concern for possible caval strut perforation. Endovascular retrieval or surgical explantation are required for removal and can be accomplished with minimal risk to the patient.

Manzur M ，Ochoa C ，Ham SW ，Lee W ，Simcox T ，Rowe V ，Weaver F ... -  《-》

Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall.

To examine the feasibility and safety of removing retrievable inferior vena cava (IVC) filters with struts external to the IVC wall on computed tomography (CT) imaging. This retrospective study included 64 IVC filter retrievals from 62 patients over a 5-year period. CT images obtained before retrieval were used to describe the various imaging characteristics of filter interactions with the IVC wall. Patient medical records were reviewed for filter type, results of filter removal with standard or nonstandard techniques, and complications. Filter struts outside the IVC wall were a common finding on CT with 55 (85.9%) filters showing some degree of perforation. Of 64 filters, 57 (89.1%) were removed successfully; 7 (10.9%) filters could not be removed because of incorporation of filter struts or tip into the IVC wall. Before retrieval, filter fracture was detected in eight (12.5%) cases, and IVC stenosis was present in three (4.7%) cases. No major complications occurred during any retrieval. Two (3.1%) cases were complicated by postprocedure abdominal pain. Both cases clinically resolved, and no abnormalities were detected on postprocedure CT. The appearance of filter struts tenting or penetrating the IVC wall is a common finding on CT performed before filter retrieval. IVC filters with these findings can be removed safely and should not be a contraindication for IVC filter retrieval.

Oh JC ，Trerotola SO ，Dagli M ，Shlansky-Goldberg RD ，Soulen MC ，Itkin M ，Mondschein J ，Solomon J ，Stavropoulos SW ... -  《-》

Contemporary management of chronic indwelling inferior vena cava filters.

Despite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended timeline. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate the contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center. A retrospective analysis was performed from August 2015 through August 2019 of all patients who were referred for removal of a prolonged IVC filter with a dwell time >1 year. Descriptive analysis was used to evaluate patients' characteristics and procedural outcomes, which were reviewed through electronic medical records. Data were expressed as median with interquartile range (IQR) or number and percentage, as appropriate. A total of 47 patients were identified with a median filter dwell time of 10.0 years (IQR, 6-13 years); 34 patients underwent IVC filter removal, and 13 patients refused retrieval. The median age of patients was 54.9 years (IQR, 42.5-64.0 years); the majority were female (57%) and white (53%). The most common indication for filter placement was high risk despite anticoagulation (49%), followed by venous thromboembolism prophylaxis (21%). The majority of patients were symptomatic (72%). If symptomatic, the most common reason for retrieval was IVC penetration (94%), and the chief complaint was pain (56%). Retrieval success was 97%, with a median length of stay of 0 days. The majority of retrievals were performed through an endovascular approach (97%). There was one postprocedural complication (3%). Despite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.

Ivanics T ，Williams P ，Nasser H ，Leonard-Murali S ，Schwartz S ，Lin JC ... -  《-》

Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review.

Montoya C ，Rey J ，Polania-Sandoval CA ，Bornak A ，Shao T ，Kenel-Pierre S ... -  《-》

Indications and Outcomes of Open Inferior Vena Cava Filter Removal.

Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make percutaneous retrieval more difficult. Open IVC filter removal is generally reserved for patients with symptoms referable to the filter, such as chronic back and abdominal pain. We present our management algorithm and review of cases of open IVC filter removal. Patients referred for management of implanted IVC filters from May 2010 to May 2016 were included. Demographic and imaging were reviewed for cases requiring open surgical removal. There were 221 percutaneous retrieval attempts in 218 patients. Successful retrieval occurred in 196 (89%) attempts. There were 7 patients who had open surgical IVC filter removal after failure of percutaneous retrieval. One patient had 2 filters and another had 3 filters. Except for 1 case with complications during the percutaneous retrieval procedure, the remaining patients all suffered from back or abdominal pain. All had significant filter strut penetration through the caval wall into adjacent structures. Postoperatively, all patients had relief of pain. There were no deaths and 1 patient had a minor ileus that spontaneously resolved. Patients who fail percutaneous IVC filter retrieval can expect low morbidity and prompt resolution of symptoms after open surgical removal via minilaparotomy.

Charlton-Ouw KM ，Afaq S ，Leake SS ，Sandhu HK ，Sola CN ，Saqib NU ，Azizzadeh A ，Safi HJ ... -  《-》