Percutaneous Extraction of Embolized Intracardiac Inferior Vena Cava Filter Struts Using Fused Intracardiac Ultrasound and Electroanatomic Mapping

Hannawa, Kevin K.; Good, Eric; Haft, Jonathan W.; Williams, David M.

doi:10.1016/j.jvir.2015.05.013

Cited by 11 publications

(7 citation statements)

References 10 publications

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“…It appears that successful intracardiac retrieval requires that an adequate-sized portion of the fragment be readily accessible, whether through a right-sided (for right ventricular fragments) or a left-sided (for left ventricular fragments) approach. Hannawa et al (18) described six patients with intracardiac fragments, all of which were successfully retrieved percutaneously in combined interventional radiology-cardiology procedures similar to one of ours. These authors emphasized the value of intracardiac echocardiography and electroanatomic mapping in achieving their impressive success rate.…”

Section: Discussionmentioning

confidence: 70%

“…The attempt rate was 60% (six of 10) (Fig 3, Fig E3 [online]). All patients with retained intracardiac fragments were referred to cardiothoracic surgery for discussion of removal, and one of these patients was performed as a combined procedure in the electrophysiology laboratory with intracardiac echocardiographic guidance, as described previously (18) (Fig 3).…”

Section: Procedure-related Resultsmentioning

confidence: 99%

“…Four of their patients had chest pain, although the cause-and-effect relationship of chest pain and filter fragments is not entirely clear given the multifactorial nature of chest pain. Their principal removal rationale appeared to be prevention of known complications such as perforation and tamponade (18). Given…”

Section: Discussionmentioning

confidence: 99%

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Management of Fractured Inferior Vena Cava Filters: Outcomes by Fragment Location

Trerotola

Stavropoulos

2017

Radiology

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Purpose To inform the management of fractured inferior vena cava filters on the basis of results from a tertiary referral center specializing in complex filter retrieval. Materials and Methods This study had institutional review board approval and was HIPAA compliant. Retrospective analysis of all patients with fractured filters and/or filter fragments evaluated for removal in a complex filter removal program was performed. Removal was attempted when fragments were intravascular or immediately extravascular by using primarily endobronchial forceps for caval fragments and snares for cardiac and pulmonary fragments. Data collected included success rate and complications of filter and fragment removal, symptoms relating to the filter or fragment, techniques used for removal, and follow-up of retained fragments. Results Sixty-five patients (12 men, 53 women) of a total of 222 patients referred for complex retrieval had fractured filters. Of these patients, two had undergone filter removal elsewhere and had retained fragments. All 63 filters were removed successfully with forceps (n = 61), a cone (n = 1), or a snare (n = 1). There were 116 separate filter fragments; removal was attempted for 78 fragments. Removal was successful for 63 (81%) of 78 fragments and varied by location. All extravascular fragments except one were retained. In all, 63 (54%) of 116 fragments were removed percutaneously, rendering 34 (54%) of 63 patients fragment free. Five minor (7.7% [five of 65]) and four major (6.2% [four of 65]) complications occurred. Conclusion Intravascular filter fragments can be removed safely with success rates that vary according to location. Because extravascular fragments are not readily accessible for removal, many patients are not rendered fragment free. RSNA, 2017 Online supplemental material is available for this article.

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Section: Discussionmentioning

confidence: 70%

Section: Procedure-related Resultsmentioning

confidence: 99%

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Management of Fractured Inferior Vena Cava Filters: Outcomes by Fragment Location

Trerotola

Stavropoulos

2017

Radiology

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“…Because of these risks, it is essential that these filters be removed and that the pros and cons of this approach be discussed with the patient during their follow-up visit. Although percutaneous extraction of embolized filter struts have previously been described ( 6 , 7 ), the present case of an embolized strut embedded in the RV free wall and septal myocardium on both ends illustrates the role for attempted percutaneous extraction in even the most difficult cases. IVC filter fractures (incidence of up to 16%) and migrations to the heart or lungs (incidence of 1.0% to 4.5%) are well-described risks with long-term filter implantation and are proportional to filter dwell time ( 6 ).…”

Section: Discussionmentioning

confidence: 71%

“…Several techniques, including the use of rigid endobronchial forceps, have been described to remove embedded, fractured, or tilted retrievable IVC filters from patients in whom standard retrieval techniques were unsuccessful ( 10 , 11 ). Similarly, techniques including use of electroanatomical mapping and 3-dimensional ultrasonography have been used to successfully remove IVC struts embolized to the right ventricle ( 7 ). The needle’s eye snare can also be used to capture a foreign body without a free end.…”

Section: Discussionmentioning

confidence: 99%