BookKush R. Desai, Osman Ahmed, Thuong Van Ha, editors.
Summary: This book addresses placement and retrieval of inferior vena cava (IVC) filters. Until 2010, utilization of IVC filters had been increasing since their introduction in 1967. Studies in the early 2000's, however, identified that prolonged caval interruption with IVC filters were fraught with complications including filter fracture, migration, and caval thrombosis. This subsequently led the FDA to issue an advisory recommending judicious placement and timely retrieval of IVC filters by treating physicians. This safety advisory ultimately created a heightened awareness by medical professionals and the general public regarding the negative consequences surrounding long-term caval filtration. Subsequently, IVC filter placements decreased nationally while retrievals conversely increased in the post-FDA advisory era. During this same time period, interest in complex IVC filter retrieval also increased as a method to manage patients identified to have or be at risk for complications secondary to prolonged filter implantation. Given these established trends and interest surrounding advanced techniques in IVC filter retrieval, this book addresses these topics in a reader-friendly, case-based format. Chapters focus particularly around the recognition and management of filter-related complications. Additionally, advanced techniques employed by experienced operators for complex filter retrieval are also discussed. For completeness, the book also includes a review of indications and appropriate methods for IVC filter placement. This book is unique in that, at present, descriptions of complications and advanced techniques utilized for complicated IVC filter removal consist mainly of case reports and case series scattered throughout the literature. This publication serves to compile these sources into a single comprehensive entity for physicians treating patients with IVC filters. Chapters are organized to begin with a few introductory paragraphs highlighting the relevant literature (and providing references for in-depth reading) followed by several cases demonstrating tips, tricks, and procedural pitfalls. When possible, each case will include a step-by-step description of the technique being described. This is an ideal guide for interventional radiologists, interventional cardiologists, and vascular surgeons that perform or are interested in performing filter retrieval beyond standard techniques.
Contents:
Intro
Contents
Contributors
1: Current Data and Trends on Inferior Vena Cava Filter Placement and Retrieval
History
Why Filters Are Inserted
Trends in Filter Placement
Trends in Filter Complications
Filter Retrieval
Conclusion
References
2: IVC Filter Placement: Accepted and Relative Indications
Introduction
Accepted Indication for IVCF Insertion
Relative and Prophylactic Indications of IVCF Insertion
Special Patient Populations
Recommendations Against IVCF Insertion
Bibliography 3: Inferior Vena Cava Filter Placement: Anatomical Evaluation and Approach to Variant Anatomy
Introduction
Embryogenesis of the Inferior Vena Cava
Procedural Technical and Anatomic Considerations
Variant Anatomic Considerations
Renal Vein Variants
Duplicated IVC
Mega Cava
Suprarenal Filter Placement Considerations
Conclusions
References
4: IVC Filter Retrieval: Routine Approach
IVC Filter Clinic
Equipment and Technique
Escalation to Complex Retrieval
References
5: Complex Filter Retrieval Planning
Introduction Defining Complex IVC Filter Retrieval
Pre-procedure Clinical Evaluation
Pre-procedure Imaging Workup
Informed Consent and Anesthetic Considerations
References
6: Filter Strut Penetration: Does It Matter?
Case 1: Retroperitoneal Fat Strut Penetration
Case 2: Filter Strut and Apex Penetration into Extra-Caval Space
Case 3: Filter Penetration into Nonvascular Organs - Bowel
Case 4: Filter Penetration into Nonvascular Organs - Spine
Case 5: Filter Strut Penetration with Aortic Involvement and Intraluminal Thrombus Case 6: Penetrating Filter Removal Complicated by Renal Arteriovenous Fistula Formation
References
7: Retrieval of Filters with Embedded Apices
Case 1: Tilted IVC Filter
Case 2: Tilted and Embedded Filter
Case 3: Deeply Embedded Filter
References
8: Filter Strut Incorporation: Tools for Success and Improved Procedural Safety
Excimer Laser-Assisted Retrieval for Filter Strut Incorporation
Case 1: Chronically Embedded Optease Filter
References
9: Mechanism and Approach to Fractured Filters
Introduction
Filter Construction
Filter Geometry Mechanism of Filter Fracture
Evaluation of a Patient with a Fractured IVCF
Fragment Characterization
Local
Technical Considerations
Extracaval Involvement
Central Embolization
Intracardiac
Technical Considerations
Intrapulmonary
Technical Considerations
Patient Preference
Understanding Limitations
Conclusions
References
10: IVC Filter Migration and Misplacement
Case 1: Pulmonary Filter Strut Migration
Case 2: Cardiac Migration of an IVC Filter
Case 3: Filter Misplacement: Azygos Vein
Case 4: Filter Misplacement: Right Renal Vein