Complex retrieval of embedded IVC filters

Alternative techniques and histologic tissue analysis

William T. Kuo, John S. Cupp, John D. Louie, Nishita Kothary, Lawrence V. Hofmann, Daniel Y. Sze, David M. Hovsepian

Research output: Contribution to journalArticle

Abstract

Purpose We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. Methods We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. Results Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. Conclusion Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.

Original languageEnglish (US)
Pages (from-to)588-597
Number of pages10
JournalCardioVascular and Interventional Radiology
Volume35
Issue number3
DOIs
StatePublished - Jun 2012
Externally publishedYes

Fingerprint

Vena Cava Filters
Histological Techniques
Hyperplasia
Fibrosis
Tulipa
Safety
Venae Cavae
Inferior Vena Cava
Pulmonary Embolism
Histology
Lasers
Thrombosis

Keywords

  • Inferior vena cava filter (IVF) placement
  • Laser treatment
  • Vena cava
  • Venous intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kuo, W. T., Cupp, J. S., Louie, J. D., Kothary, N., Hofmann, L. V., Sze, D. Y., & Hovsepian, D. M. (2012). Complex retrieval of embedded IVC filters: Alternative techniques and histologic tissue analysis. CardioVascular and Interventional Radiology, 35(3), 588-597. https://doi.org/10.1007/s00270-011-0175-1

Complex retrieval of embedded IVC filters : Alternative techniques and histologic tissue analysis. / Kuo, William T.; Cupp, John S.; Louie, John D.; Kothary, Nishita; Hofmann, Lawrence V.; Sze, Daniel Y.; Hovsepian, David M.

In: CardioVascular and Interventional Radiology, Vol. 35, No. 3, 06.2012, p. 588-597.

Research output: Contribution to journalArticle

Kuo, WT, Cupp, JS, Louie, JD, Kothary, N, Hofmann, LV, Sze, DY & Hovsepian, DM 2012, 'Complex retrieval of embedded IVC filters: Alternative techniques and histologic tissue analysis', CardioVascular and Interventional Radiology, vol. 35, no. 3, pp. 588-597. https://doi.org/10.1007/s00270-011-0175-1
Kuo, William T. ; Cupp, John S. ; Louie, John D. ; Kothary, Nishita ; Hofmann, Lawrence V. ; Sze, Daniel Y. ; Hovsepian, David M. / Complex retrieval of embedded IVC filters : Alternative techniques and histologic tissue analysis. In: CardioVascular and Interventional Radiology. 2012 ; Vol. 35, No. 3. pp. 588-597.
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N2 - Purpose We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. Methods We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. Results Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. Conclusion Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.

AB - Purpose We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. Methods We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. Results Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. Conclusion Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.

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