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Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes

PURPOSE: To present the techniques for endovascular treatment of thrombosed filter-bearing inferior vena cavae (IVCs), along with short-term clinical and imaging follow-up. MATERIALS AND METHODS: A total of 45 consecutive patients (17 females and 28 males), aged 19-79 years (mean age of 49 years), w...

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Autores principales: Arabi, Mohammad, Krishnamurthy, Venkataramu, Cwikiel, Wojciech, Vellody, Ranjith, Wakefield, Thomas W, Rectenwald, John, Williams, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531446/
https://www.ncbi.nlm.nih.gov/pubmed/26288516
http://dx.doi.org/10.4103/0971-3026.161436
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author Arabi, Mohammad
Krishnamurthy, Venkataramu
Cwikiel, Wojciech
Vellody, Ranjith
Wakefield, Thomas W
Rectenwald, John
Williams, David
author_facet Arabi, Mohammad
Krishnamurthy, Venkataramu
Cwikiel, Wojciech
Vellody, Ranjith
Wakefield, Thomas W
Rectenwald, John
Williams, David
author_sort Arabi, Mohammad
collection PubMed
description PURPOSE: To present the techniques for endovascular treatment of thrombosed filter-bearing inferior vena cavae (IVCs), along with short-term clinical and imaging follow-up. MATERIALS AND METHODS: A total of 45 consecutive patients (17 females and 28 males), aged 19-79 years (mean age of 49 years), who had IVC filter placement complicated by symptomatic acute or chronic iliocaval thrombosis and underwent endovascular therapy were studied. All patients presented with lower extremity swelling and/or pain. One patient also had bilateral lower extremity swelling and chronic gastrointestinal (GI) bleeding which was secondary to chronic systemic to portal venous collaterals. Patients underwent one or more of the following endovascular treatments depending on the chronicity and extent of thrombosis: (a) catheter-directed thrombolysis (CDT) (n = 25), (b) pharmacomechanical thrombolysis (PMT) (n = 15), (c) balloon angioplasty (n = 45), and/or (d) stent placement across the filter (n = 42). In addition, 16 patients underwent groin arteriovenous fistula (AVF) creation (36%) and 3 (7%) had femoral venous thrombectomy to improve flow in the recanalized iliac veins and IVCs. RESULTS: Anatomical success was achieved in all patients. Follow-up was not available in 10 patients (lost to follow-up, n = 4; expired due to comorbidities, n = 2; lost to follow-up after re-intervention, n = 4). At a mean follow-up time of 13.3 months (range 1-48 months), clinical success was achieved in 27 patients (60%), i.e. in 21 patients without re-intervention and in 6 patients with re-intervention. Clinical success was not achieved despite re-intervention in eight patients. Higher clinical success was noted in patients who did not require repeat interventions (P = 0.03) and the time to re-intervention was significantly shorter in patients who had clinical failure (P = 0.01). AVF creation did not improve the clinical success rate (P = 1). There was no significant difference in clinical success between patients who had acute or subacute thrombosis compared to those who had chronically occluded filter-bearing IVCs (P = 1). CONCLUSION: This study suggests that endovascular therapy for thrombosed filter-bearing IVCs is safe and technically feasible.
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spelling pubmed-45314462015-08-18 Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes Arabi, Mohammad Krishnamurthy, Venkataramu Cwikiel, Wojciech Vellody, Ranjith Wakefield, Thomas W Rectenwald, John Williams, David Indian J Radiol Imaging Vascular and Interventional Radiology PURPOSE: To present the techniques for endovascular treatment of thrombosed filter-bearing inferior vena cavae (IVCs), along with short-term clinical and imaging follow-up. MATERIALS AND METHODS: A total of 45 consecutive patients (17 females and 28 males), aged 19-79 years (mean age of 49 years), who had IVC filter placement complicated by symptomatic acute or chronic iliocaval thrombosis and underwent endovascular therapy were studied. All patients presented with lower extremity swelling and/or pain. One patient also had bilateral lower extremity swelling and chronic gastrointestinal (GI) bleeding which was secondary to chronic systemic to portal venous collaterals. Patients underwent one or more of the following endovascular treatments depending on the chronicity and extent of thrombosis: (a) catheter-directed thrombolysis (CDT) (n = 25), (b) pharmacomechanical thrombolysis (PMT) (n = 15), (c) balloon angioplasty (n = 45), and/or (d) stent placement across the filter (n = 42). In addition, 16 patients underwent groin arteriovenous fistula (AVF) creation (36%) and 3 (7%) had femoral venous thrombectomy to improve flow in the recanalized iliac veins and IVCs. RESULTS: Anatomical success was achieved in all patients. Follow-up was not available in 10 patients (lost to follow-up, n = 4; expired due to comorbidities, n = 2; lost to follow-up after re-intervention, n = 4). At a mean follow-up time of 13.3 months (range 1-48 months), clinical success was achieved in 27 patients (60%), i.e. in 21 patients without re-intervention and in 6 patients with re-intervention. Clinical success was not achieved despite re-intervention in eight patients. Higher clinical success was noted in patients who did not require repeat interventions (P = 0.03) and the time to re-intervention was significantly shorter in patients who had clinical failure (P = 0.01). AVF creation did not improve the clinical success rate (P = 1). There was no significant difference in clinical success between patients who had acute or subacute thrombosis compared to those who had chronically occluded filter-bearing IVCs (P = 1). CONCLUSION: This study suggests that endovascular therapy for thrombosed filter-bearing IVCs is safe and technically feasible. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4531446/ /pubmed/26288516 http://dx.doi.org/10.4103/0971-3026.161436 Text en Copyright: © Indian Journal of Radiology and Imaging http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Vascular and Interventional Radiology
Arabi, Mohammad
Krishnamurthy, Venkataramu
Cwikiel, Wojciech
Vellody, Ranjith
Wakefield, Thomas W
Rectenwald, John
Williams, David
Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title_full Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title_fullStr Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title_full_unstemmed Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title_short Endovascular treatment of thrombosed inferior vena cava filters: Techniques and short-term outcomes
title_sort endovascular treatment of thrombosed inferior vena cava filters: techniques and short-term outcomes
topic Vascular and Interventional Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531446/
https://www.ncbi.nlm.nih.gov/pubmed/26288516
http://dx.doi.org/10.4103/0971-3026.161436
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