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

Abstract

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.

Keywords

Inferior vena cavae filter - recanalization - thrombosis

Publication History

Article published online:
30 July 2021

• References

• 1 Hammond CJ, Bakshi DR, Currie RJ, Patel JV, Kinsella D, McWilliams RG, et al. Audit of the use of IVC filters in the UK: Experience from three centres over 12 years. Clin Radiol 2009;64:502-10.
• 2 Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d′Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998;338:409-15.
• 3 Spencer FA, Bates SM, Goldberg RJ, Lessard D, Emery C, Glushchenko A, et al. A population-based study of inferior vena cava filters in patients with acute venous thromboembolism. Arch Intern Med 2010;170:1456-62.
• 4 Kinney TB. Update on inferior vena cava filters. J Vasc Interv Radiol 2003;14:425-40.
• 5 Nazzal M, Chan E, Nazzal M, Abbas J, Erikson G, Sediqe S, et al. Complications related to inferior vena cava filters: A single-center experience. Ann Vasc Surg 2010;24:480-6.
• 6 Streiff MB. Vena caval filters: A comprehensive review. Blood 2000;95:3669-77.
• 7 Kim HS, Young MJ, Narayan AK, Hong K, Liddell RP, Streiff MB. A comparison of clinical outcomes with retrievable and permanent inferior vena cava filters. J Vasc Interv Radiol 2008;19:393-9.
• 8 Given MF, McDonald BC, Brookfield P, Niggemeyer L, Kossmann T, Varma DK, et al. Retrievable Gunther Tulip inferior vena cava filter: Experience in 317 patients. J Med Imaging Radiat Oncol 2008;52:452-7.
• 9 Kalva SP, Athanasoulis CA, Fan CM, Curvelo M, Geller SC, Greenfield AJ, et al. "Recovery" vena cava filter: Experience in 96 patients. Cardiovasc Intervent Radiol 2006;29:559-64.
• 10 Vedantham S, Vesely TM, Parti N, Darcy MD, Pilgram TK, Sicard GA, et al. Endovascular recanalization of the thrombosed filter-bearing inferior vena cava. J Vasc Interv Radiol 2003;14:893-903.
• 11 Neglen P, Oglesbee M, Olivier J, Raju S. Stenting of chronically obstructed inferior vena cava filters. J Vasc Surg 2011;54:153-61.
• 12 Sildiroglu O, Ozer H, Turba UC. Management of the thrombosed filter-bearing inferior vena cava. Semin Intervent Radiol 2012;29:57-63.
• 13 Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, et al.; CIRSE and SIR Standards of Practice Committees. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 2009;20(Suppl):S227-39.
• 14 Bjarnason H, Kruse JR, Asinger DA, Nazarian GK, Dietz CA Jr, Caldwell MD, et al. Iliofemoral deep venous thrombosis: Safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol 1997;8:405-18.
• 15 Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000;11:1297-302.
• 16 Enden T, Kløw NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: Results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost 2009;7:1268-75.
• 17 Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ; American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. (8 th Edition). Chest 2008;133(Suppl):454S-545S.
• 18 Fruhwirth J, Gutschi S, Amann W, Luschin-Ebengreuth G, Uggowitzer M. Results of surgical treatment of pregnancy-associated pelvic vein thrombosis. Z Geburtshilfe Neonatol 1997;201:91-4.
• 19 Törngren S, Swedenborg J. Thrombectomy and temporary arterio-venous fistula for ilio-femoral venous thrombosis. Int Angiol 1988;7:14-8.
• 20 Matchett WJ, Jones MP, McFarland DR, Ferris EJ. Suprarenal vena caval filter placement: Follow-up of four filter types in 22 patients. J Vasc Interv Radiol 1998;9:588-93.
• 21 Kalva SP, Chlapoutaki C, Wicky S, Greenfield AJ, Waltman AC, Athanasoulis CA. Suprarenal inferior vena cava filters: A 20-year single-center experience. J Vasc Interv Radiol 2008;19:1041-7.