Vena Caval Occlusion after Simon Nitinol Filter Placement: Identification with MR Imaging in Patients with Malignancy

Matsumoto, Alan H.; Teitelbaum, George P.

doi:10.1016/s1051-0443(92)72008-9

Cited by 47 publications

(15 citation statements)

References 20 publications

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“…IVC thrombosis generally has been identified by selectively investigating patients with lower extremity edema or using either abdominal radiographs (to identify a reduction in filter span characteristic of clot retraction), ultrasonography, CT, or angiography. Rarely, MRI has been employed (55,71,73). While the overall prevalence of IVCT in case series is low, the substantial ranges that accompany the mean values displayed in the table confirm that widely varying rates have been seen.…”

Section: Do Vena Caval Filters Provide Greater Protection Against Pe mentioning

confidence: 89%

Vena Caval Filters: A Review for Intensive Care Specialists

Streiff

2003

J Intensive Care Med

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Venous thromboembolism (VTE) is a common complication among patients in the intensive care unit. While anticoagulation remains standard therapy, vena caval filters are an important alternative when anticoagulation is contraindicated. To determine the safety and efficacy of vena caval filters in the treatment of VTE, a comprehensive review of the English-language medical literature was performed. Except for one randomized controlled trial, the literature supporting the use of vena caval filters consists almost exclusively of case series, which in many instances are limited by incomplete and short follow-up. While case series suggest that filters function effectively in the prevention of pulmonary embolism (2%-4% symptomatic pulmonary embolism [PE], fatal PE < 2%), recent higher quality studies indicate that filters may not provide significant additional protection to that provided by anticoagulation alone. Furthermore, filters are associated with a 2- fold increase in the incidence of recurrent DVT. Until randomized comparative studies are available, the safety and efficacy of all the available devices should be considered to be roughly equivalent. Since filters do not inhibit continued clot formation, all filter patients should receive anticoagulation for durations appropriate for their thrombotic disorder. Although extended anticoagulation may prevent thrombotic complications associated with filter placement, this strategy has yet to be experimentally tested. While many additional indications for vena caval filter use have been proposed (VTE in cancer patients, PE prophylaxis in trauma patients, etc), well-designed clinical trials demonstrating their efficacy in these situations are lacking. Further development of temporary/retrievable filters, which offer the potential to avoid the long-term complications of permanent filters, should be a research priority. Until additional data are available, vena caval filters should generally be restricted to patients with VTE who cannot receive anticoagulation.

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Section: Do Vena Caval Filters Provide Greater Protection Against Pe mentioning

confidence: 89%

Vena Caval Filters: A Review for Intensive Care Specialists

Streiff

2003

J Intensive Care Med

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“…10,15,37 The Greenfield filter may still be useful in patients with healthy lungs that may tolerate small emboli, 36 while those with poor pulmonic function may require the greater safety of a more efficient filter, despite the risk of caval occlusion. 7,15,22 Regardless of filter efficiency, the position of the captured clot may affect clot dissolution. Theoretically a clot near the wall would be more problematic due to filter occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…9 In contrast, the two-stage Simon Nitinol filter showed a caval occlusion rate of about 21%. 7 In a study comparing filters vs. no filters in 400 patients, 31 the incidence of pulmonary embolism was significantly less in those patients receiving filters. Four filter types were used, but stratification by filter type was not performed.…”

Section: In Vivo Studiesmentioning

confidence: 99%

Effects of Thrombosed Vena Cava Filters on Blood Flow: Flow Visualization and Numerical Modeling

et al. 2008

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Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE) in patients with deep vein thrombosis for whom anticoagulation is contraindicated. IVC filters have been shown to be effective in trapping embolized clots and preventing PE; however, among the commercially available designs, the optimal balance of clot capture efficiency, clot dissolution, and prevention of to vena cava occlusion is unknown. Clot capture efficiency has been quantified in numerous in vitro studies, in which model clots are released into a mock circulation system, with the relative capture efficiency of various IVC filters analyzed statistically. In general, two-stage filters have been found to be more efficient than one-stage filters. However, other factors may play a role in the ultimate dissolution of clots and in the overall effect of the resulting blood flow on caval vasculature. Clot dissolution has been shown to increase with increasing wall shear stress, while low and oscillating wall shear stresses are known to have a deleterious effect on vessel walls, causing intimal hyperplasia. This paper describes the effect of IVC filters on blood flow, velocity patterns, and wall shear stress by flow visualization and computational fluid dynamics.

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“…The long-term complications include mechanical filter fracture, 20 -22 filter migration, 23 caval perforation, 24 and filter thrombosis. 25 The highest risk of filter dislodgment is in the first 2 weeks after placement before endothelialization of the filter. 26 Intravascular wires can cause many problems with IVC filters.…”

Section: Discussionmentioning

confidence: 99%