REGULAR CONTENT
Final ID
568
Type
Original Scientific Research-Oral or Pos
Authors
S Seedial1, K Desai1, R Salem1, J Karp2, R Lewandowski1
Institutions
1Northwestern University, Chicago, IL, 2Northwestern Memorial Hospital, Chicago, IL
Purpose
Caval perforation by IVC filters (IVCF) is common; when strut perforation occurs into pericaval viscera, there is potential for adverse events (AEs) during a retrieval procedure. We aim to evaluate the safety and technical success of retrieval of IVCF with struts perforating into the pericaval viscera.
Materials & Methods
We conducted a retrospective, IRB–approved study of IVCF retrievals (2011-2016) in patients with CT findings of perforating struts into adjacent vessels, organs or bone. Symptoms, technical success, use of advanced retrieval techniques and AEs were evaluated; significance was accepted at p<0.05.
Results
27 patients had IVCF struts perforating, abutting or penetrating the aorta (18), superior mesenteric artery (1), pancreas (1), psoas muscle (1), duodenum (11), gonadal vein (1) and vertebral bodies (13). Filters encountered were: Celect (10), Günther Tulip (8), Simon Nitinol (2), Eclipse (2), Denali (2), G2 (2), ALN (1) and TrapEase (1). IVCF retrieval was successful in 25 attempted cases; 2 patients refused retrieval. The use of advanced techniques was required in the majority of cases (88%). One case was complicated by filter fracture during the procedure; a single strut embolized to the left pulmonary artery and was unable to be retrieved. Seven patients had fractured struts on pre-procedural imaging; most (6/7) of these struts were extra-caval (these extra-caval struts were not retrieved). The single fractured intracaval strut was successfully retrieved. Five of 7 patients with fractured struts presented with back or abdominal pain (OR 22.5, 95% CI 2.5-202 p<0.006). Seventy-one percent of patients presenting with pain reported resolution of symptoms after removal.
Conclusions
Removal of IVCF with perforation into adjacent structure is safe, frequently requiring advanced retrieval techniques. Filter fracture appears to correlate with clinical symptoms; IVCF retrieval can resolve pain. IVCF retrieval is recommended to reduce the risk of device-related complications while in situ, thereby adhering to the 2014 FDA safety communication.
Final ID
568
Type
Original Scientific Research-Oral or Pos
Authors
S Seedial1, K Desai1, R Salem1, J Karp2, R Lewandowski1
Institutions
1Northwestern University, Chicago, IL, 2Northwestern Memorial Hospital, Chicago, IL
Purpose
Caval perforation by IVC filters (IVCF) is common; when strut perforation occurs into pericaval viscera, there is potential for adverse events (AEs) during a retrieval procedure. We aim to evaluate the safety and technical success of retrieval of IVCF with struts perforating into the pericaval viscera.
Materials & Methods
We conducted a retrospective, IRB–approved study of IVCF retrievals (2011-2016) in patients with CT findings of perforating struts into adjacent vessels, organs or bone. Symptoms, technical success, use of advanced retrieval techniques and AEs were evaluated; significance was accepted at p<0.05.
Results
27 patients had IVCF struts perforating, abutting or penetrating the aorta (18), superior mesenteric artery (1), pancreas (1), psoas muscle (1), duodenum (11), gonadal vein (1) and vertebral bodies (13). Filters encountered were: Celect (10), Günther Tulip (8), Simon Nitinol (2), Eclipse (2), Denali (2), G2 (2), ALN (1) and TrapEase (1). IVCF retrieval was successful in 25 attempted cases; 2 patients refused retrieval. The use of advanced techniques was required in the majority of cases (88%). One case was complicated by filter fracture during the procedure; a single strut embolized to the left pulmonary artery and was unable to be retrieved. Seven patients had fractured struts on pre-procedural imaging; most (6/7) of these struts were extra-caval (these extra-caval struts were not retrieved). The single fractured intracaval strut was successfully retrieved. Five of 7 patients with fractured struts presented with back or abdominal pain (OR 22.5, 95% CI 2.5-202 p<0.006). Seventy-one percent of patients presenting with pain reported resolution of symptoms after removal.
Conclusions
Removal of IVCF with perforation into adjacent structure is safe, frequently requiring advanced retrieval techniques. Filter fracture appears to correlate with clinical symptoms; IVCF retrieval can resolve pain. IVCF retrieval is recommended to reduce the risk of device-related complications while in situ, thereby adhering to the 2014 FDA safety communication.