Info

"DVT = deep venous thrombosis; bPE = pulmonary embolism.

"DVT = deep venous thrombosis; bPE = pulmonary embolism.

TrapEase filter

FIGURE 47.1 Thrombus both within and above a filter (inset) demonstrated by venogram in a patient who developed massive pulmonary embolism despite the presence of an infrarenal Recovery filter. A suprarenal Günther-Tulip filter was placed to protect against further embolism until anticoagulation could be initiated.

FIGURE 47.1 Thrombus both within and above a filter (inset) demonstrated by venogram in a patient who developed massive pulmonary embolism despite the presence of an infrarenal Recovery filter. A suprarenal Günther-Tulip filter was placed to protect against further embolism until anticoagulation could be initiated.

composite rate of pulmonary embolism of 2.6%, with a range between 0 to 9%.9,10 The composite rates for the other available filters were TG 3.1% (range 0-3.8%), BN 2.9% (range 0-4.2%), SN 3.8% (range 0-5.3%), and VT 3.4% (range 0-8%). The rates of fatal pulmonary embolism were between 0.3% in the VT series up to 1.9% for the SN filter.910 Athanasoulis et al. documented a fatal PE rate of 3.7% following filter insertion in a 26-year review of their IVC filter experience.17 No recurrent PE was documented in the single trial using the TrapEase filter.18 The rates reported for recurrent symptomatic pulmonary embolism and fatal pulmonary embolism are not negligible. Studies have not addressed clinical conditions likely to predispose to this complication.

In a patient with suspected pulmonary embolism, PE protocol chest computed tomography (CT), pulmonary angi-ography, or ventilation/perfusion nuclear medicine lung scanning should be performed. If the diagnosis is confirmed, the source of the event should also be identified. IVC filter thrombosis can be investigated using contrast enhanced abdominal CT with venous phase imaging or contrast vena cavography. Duplex ultrasound of unprotected venous beds should also be performed to evaluate other potential sources of embolism.

FIGURE 47.2 Chronic IVC and filter thrombosis demonstrated below a TrapEase filter. Collateral venous drainage is noted.

Inferior Vena Cava Thrombosis or Occlusion

IVC thrombosis may result from innate thrombogenicity of the filter, trapped emboli within the filter, or propagation of thrombus through the venous system up to and including the filter (see Figure 47.2). The PREPIC trial documented symptomatic IVC thrombosis in 13% of patients after eight years of follow-up.16 Other reports have documented IVC filter thrombosis rates from 0 to 31%. Once again the SSG and BN filters have documented the lowest rates of IVC thrombosis, 3.6% and 3.9%, respectively. The highest rates of IVC thrombosis occurred with the VT filter, 11.2%.9 In initial studies, the TrapEase filter had a documented IVC filter thrombosis rate at six months of 3.1%.18

Studies of optionally retrievable filters have documented IVC thrombosis in 0 to 9.6% of patients with the Gunther-Tulip filters.11,19 In addition, thrombus trapped within the filter at attempted retrieval has been documented in 10% of Gunther-Tulip and 22% of Recovery filters, suggesting the filters may have performed well in preventing pulmonary emboli,11 but this could lead to eventual caval thrombosis if the filter is not removed. Longer follow-up is required to determine if the rates of IVC thrombosis in optionally

Bird's nest filter A

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