Right heart catheterization in the presence of an inferior vena cava filter

Abstract

Inferior vena cava filters are being inserted with increasing frequency. When such patients later require right heart catheterization, brachial or jugular vein access is usually attempted. We describe our experience in 10 consecutive patients using the standard femoral approach, first assessing filter patency and then carefully crossing the filter using a straight guidewire. The right heart chambers were successfully accessed in every case. There were no complications, and in no case did the filter migrate or become dislodged. This technique may prove useful when right heart catheterization is indicated in a patient who has a Greenfield inferior vena cava filter.

Cavotricuspid Isthmus Catheter Ablation Across an Inferior Vena Cava Filter

“…There are few data regarding cardiac catheterization procedures across an IVC filter 1–5 . Although adverse events related to the IVC filter did not occur in these cases, other reports have described complications such as filter migration or dislodgement as well as guidewire entrapment 6–8 .…”

“…A small population of patients who have failed medical management of pulmonary embolism have undergone placement of an inferior vena cava (IVC) filter. While there are reported series of patients who have undergone diagnostic right heart catheterization, extraction of a defibrillator lead, or transcatheter device closure of an atrial septal defect in the presence of an IVC filter, 1–5 no data are available regarding catheter ablation of cardiac arrhythmias for this patient population.…”

Percutaneous closure of patent foramen ovale guided by intracardiac echocardiography and performed through the transfemoral approach in the presence of previously placed inferior vena cava filters: A case series

“…Percutaneous PFO closure in such patients carries the risk of dislodging and/or embolizing the filter or lacerating the inferior vena cava during manipulation, since large-caliber venous sheaths would have to go through the IVC filter. While these patients can undergo right heart catheterization through the internal jugular veins, subclavian veins, or via the transhepatic approach [11], PFO closure through these approaches is technically demanding due to the relatively large size of sheaths used in the procedure and the difficulty in accurate device positioning and deployment that would result from the delivery system being at an acute angle in relation to the IAS. Recent reports have shown that PFO closure through a previously implanted IVC filter is technically feasible and can be safely performed without complications [12,13].…”

Percutaneous Closure of a Patent Foramen Ovale via Left Axillary Vein Approach with the Amplatzer Cribriform Septal Occluder

“…As the practice of percutaneous closure continues to advance, anatomical variants and obstacles will be encountered. Although transit through IVC filters with diagnostic and Swan‐Ganz catheters is often performed, this may not be possible depending on the specific IVC filter, particularly in the presence of common femoral, common iliac, or IVC thrombus 7–10 . Furthermore, device entrapment and dislodgement is a well‐described complication and there are no reports of IVC filter passage in this particular device 11,12 .…”