Use of Retrievable Filters in Alternative Common Iliac Vein Location in High-risk Surgical Patients

Ha, Thuong G. Van; Dillon, Patrick; Funaki, Brian; Zangan, S.; Lorenz, Jonathan M.; Piano, Giancarlo; Regalado, Sidney

doi:10.1016/j.jvir.2010.09.033

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…The majority of authors against migration, as two projections are not adequate to evaluate filter anchoring to the vein wall. Interestingly, the classical concept of megacava (transverse diameter > 28-30 mm) [27][28][29] as measured in two-dimensional venography is still used as a contraindication for filter placement, but we believe this definition should be revised based on more accurate diameter assessments measured by CT [12] . In the current study, we identified a significant decrease in IVC size during Valsalva maneuvers to just 20%-25% of the full IVC area observed during neutral breathing.…”

Section: Discussionmentioning

confidence: 99%

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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AIM:To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications. METHODS:This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, threedimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas. RESULTS:The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm 2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm 2 (IR) during the Valsalva (P s < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (P s < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva. CONCLUSION:Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant de-

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Section: Discussionmentioning

confidence: 99%

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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“…The safety and efficacy of filters in iliac vessels have been reported previously. 6 , 7 In a 2011 series by Van Ha et al, 8 of 20 filters placed in the common iliac vein, there were no procedure-related complications, no clinically evident pulmonary embolus, and a 100% filter retrieval rate. In our case, filter placement in the common iliac vein would be above the renal inflow, so it was placed in the external iliac vein.…”

Section: Discussionmentioning

confidence: 98%

Surgical removal of venous filter and snare complex in a patient with solitary left pelvic kidney

Gupta¹,

Brar²,

Pope³

2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Anticoagulation is used to prevent thromboembolism; inferior vena cava filters are an alternative in patients with contraindications to anticoagulation. Although it is safe and effective, there are recognized complications related to inferior vena cava filter placement. We describe the case of a young man with congenital solitary left pelvic kidney who required unique filter placement to suit the anatomy and surgical removal after entrapment of the filter-snare complex in the left internal iliac vein. Patients may also acquire solitary pelvic kidneys after renal transplantation. This anatomy poses unique challenges to venous filter placement and requires tailored management.

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“…3 , 4 The use of permanent filters in the iliac veins must warrant caution, owing to the higher risk of associated filter-related DVT due to the smaller venous caliber. 14 More recently, Van Ha et al 5 reported the placement and retrieval of the Günther-Tulip filter (Cook Medical Inc) from the CIV for prophylactic interruption of venous return in 10 high-risk surgical patients. In contrast to these studies, we have described the placement and retrieval of temporary filters in the EIV in addition to the CIV.…”

Section: Discussionmentioning

confidence: 99%

“… 2 In patients with mega cava, the placement of IVC filters in the iliac veins can serve as a feasible alternative; however, most of these studies had investigated permanent filters. 3 , 4 , 5 Also, iliac vein filter placement and retrieval have not been well described in the current literature. In the present report, we have described the successful placement and retrieval of bilateral iliac vein filters in two patients with mega cava, active venous thromboembolism (VTE), and contraindications to anticoagulation.…”

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confidence: 99%