Recurrent deep venous thrombosis and inferior vena cava (IVC) thrombosis are well-described complications following IVC filter placement. IVC thrombosis ranges in severity of clinical presentation, but can lead to significant morbidity and mortality with incidence rates depending on patient population and type of filter used. Endovascular therapies such as catheter-directed thrombolysis, mechanical thrombectomy, balloon venoplasty, and stenting are safe and effective in restoration of venous patency.
plexus, subclavian artery or subclavian vein. Venous TOS may present with upper extremity swelling, pain or deep venous thrombosis (DVT). Management of venous TOS is controversial, with catheter directed therapies such as thrombolysis and angioplasty often supplementing surgical decompression. We retrospectively evaluate a single-center series of venous TOS patients. Materials and Methods: Retrospective analysis of consecutive patients who underwent venography at our institution for venous TOS was performed. 69 patients with venous TOS symptoms from January 2004 to September 2014 were identified. Patient parameters, presenting symptoms, endovascular and surgical management and clinical follow-up were recorded. Results: Of the 69 patients, 43 (62%) were diagnosed with venous TOS due to acute upper extremity DVT with 34 (34/43, 79%) undergoing catheter directed thrombolysis and angioplasty. The remaining patients (26/69, 38%) presented with chronic symptoms of venous hypertension. 69 patients underwent venography with 60 (87%) having evidence of TOS on at least one side (19 bilaterally). 53 (53/60, 88%) underwent surgical decompression. Of 38 patients with documented left or right hand dominance and unilateral decompression, 55% (21/38) required ipsilateral decompression and 45% the nondominant side. Of the 53 undergoing decompression, 45 (85%) had post-surgical venography. 39 (39/45, 87%) required angioplasty, 3 had no angiographic stenosis and 3 had chronic subclavian vein occlusion. Of 39 patients with post-decompression angioplasty, only 4 (10%) had repeat venography due to non-resolution or recurrence of symptoms, while 35 (35/ 39, 90%) remained symptom-free. Average follow-up was 36 months. Although no complications from venography or angioplasty were reported, 1 patient developed thrombolysisrelated heparin induced thrombocytopenia. Conclusion: Venography, angioplasty, and thrombolysis are safe procedures in treatment of venous TOS. The majority of patients undergoing surgical decompression required postprocedure angioplasty, with good long-term results and low recurrence of venous TOS symptoms.
Purpose: Failure of inferior vena cava filter retrieval has been reported to be as high as 43%. Declaring a filter that was failed to be retrieved as a "permanent" device may not be acceptable, given the significant incidence of device-related complications. In this study, we aimed to assess outcomes of patients with failed IVCF retrievals who were referred for further management to a national, tertiary care center. Materials: A prospectively acquired database of IVCF retrieval procedures was reviewed from January 1, 2009 through June 30, 2015. Cases that were referred to a tertiary, national referral center that failed retrieval elsewhere were identified. Demographics studied included patient age, sex, filter type, dwell time, retrieval success rate, complications, and use of adjunctive techniques. Dwell times in the upper 75th percentile were defined as high for this study. Comparisons were made with Fisher's exact test. Results: 24 patients were identified that failed initial IVCF retrieval at an outside institution or by a specialty other than Interventional Radiology. 46% were male. Mean age was 46.2 years. Mean dwell time was 409 days (range 17-2963 days). 100% of IVCFs referred for failed retrieval from elsewhere were successfully removed. Minor complications were seen in 8 patients (33%) including: minor access site complications (3 patients), trace IVC extravasation (4), filter migration during removal (1). No major complications were reported. Advanced filter retrieval techniques were used in 100% of patients including: laser (18 patients), endobronchial forceps (8), loop snare (7). There was no difference in complication rate with higher dwell times (p ¼ 0.64). Conclusions: Referral of failed retrievals to an experienced center resulted in 100% retrieval success rate with no major complications. This suggests that any filter that fails conventional removal techniques should not be declared permanent but rather referred to a regional or national center for additional management and successful retrieval.
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