Top

Published in:

01-04-2016 | Original Article

IVC filter retrieval in adolescents: experience in a tertiary pediatric center

Authors: Anthony K. Guzman, Mahmoud Zahra, Scott O. Trerotola, Leslie J. Raffini, Maxim Itkin, Marc S. Keller, Anne Marie Cahill

Published in: Pediatric Radiology | Issue 4/2016

Abstract

Background

Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined.

Objective

To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications.

Materials and methods

A retrospective 10-year review was performed of 20 children (13 male, 7 female), mean age: 15.1 years (range: 12-19 years), who underwent IVC filter retrieval. Eleven of 20 (55%) were placed in our institution. Electronic medical records were reviewed for filter characteristics, retrieval technique, technical success and complications.

Results

The technical success rate was 100%. Placement indications included: deep venous thrombosis with a contraindication to anticoagulation (10/20, 50%), free-floating thrombus (4/20, 20%), post-trauma pulmonary embolism prophylaxis (3/20, 15%) and pre-thrombolysis pulmonary patient (1/20, 5%). The mean implantation period was 63 days (range: 20-270 days). Standard retrieval was performed in 17/20 patients (85%). Adjunctive techniques were performed in 3/20 patients (15%) and included the double-snare technique, balloon assistance and endobronchial forceps retrieval. Median procedure time was 60 min (range: 45-240 min). Pre-retrieval cavogram demonstrated filter tilt in 5/20 patients (25%) with a mean angle of 17° (range: 8-40). Pre-retrieval CT demonstrated strut wall penetration and tip embedment in one patient each. There were two procedure-related complications: IVC mural dissection noted on venography in one patient and snare catheter fracture requiring retrieval in one patient. There were no early or late complications.

Conclusion

In children, IVC filter retrieval can be performed safely but may be challenging, especially in cases of filter tilt or embedding. Adjunctive techniques may increase filter retrieval rates.

Chalmers EA (2006) Epidemiology of venous thromboembolism in neonates and children. Thromb Res 118:3–12CrossRefPubMed

Johnson C, Alomari AI, Chaudry G (2011) Detachment of introducer sheath radiopaque marker during retrieval of G2 filter. Cardiovasc Intervent Radiol 34:431–434CrossRefPubMed

Raffini L, Cahill AM, Hellinger J (2008) A prospective observational study of IVC filters in pediatric patients. Pediatr Blood Cancer 51:517–520

Takemoto CM, Sohi S, Desai K et al (2014) Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 164:332–338CrossRefPubMed

Caplin DM, Nikolic B, Kalva SP et al (2011) Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol 22:1499–1506PubMed

Kaufman JA, Kinney TB, Streiff MB et al (2006) Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. Surg Obes Relat Dis 2:200–212CrossRefPubMed

Kukreja KU, Gollamudi J, Patel MN et al (2011) Inferior vena cava filters in children: our experience and suggested guidelines. J Pediatr Hematol Oncol 33:334–338CrossRefPubMed

Chaudry G, Padua HM, Alomari AI (2008) The use of inferior vena cava filters in young children. J Vasc Interv Radiol 19:1103–1106CrossRefPubMed

Sridhar AV, Rao NK, Chakraborty S (2005) A six-year old with fatal pulmonary embolism. Acta Paediatr 94:977–979CrossRefPubMed

10.

Gunta S, Kamath S (2012) A case of pulmonary embolism and stroke in a 16-year-old girl. WMJ 111:58–60PubMed

11.

Nazzal M, Chan E, Nazzal M et al (2010) Complications related to inferior vena cava filters: a single-center experience. Ann Vasc Surg 24:480–486CrossRefPubMed

12.

Ahmad I, Yeddula K, Wicky S et al (2010) Clinical sequelae of thrombus in an inferior vena cava filter. Cardiovasc Intervent Radiol 33:285–289CrossRefPubMed

13.

Durack JC, Westphalen AC, Kekulawela S et al (2012) Perforation of the IVC: rule rather than exception after longer indwelling times for the Gunther Tulip and Celect retrievable filters. Cardiovasc Intervent Radiol 35:299–308CrossRefPubMed

14.

Malgor RD, Hines GL, Terrana L et al (2012) Persistent abdominal pain caused by an inferior vena cava filter protruding into the duodenum and the aortic wall. Ann Vasc Surg 26:e3–e6CrossRefPubMed

15.

Sarosiek S, Crowther M, Sloan JM (2013) Indications, complications, and management of inferior vena cava filters: the experience in 952 patients at an academic hospital with a level I trauma center. JAMA Intern Med 173:513–517CrossRefPubMed

16.

Rimon U, Bensaid P, Golan G et al (2011) Optease vena cava filter optimal indwelling time and retrievability. Cardiovasc Intervent Radiol 34:532–535CrossRefPubMed

17.

Al-Hakim R, Kee ST, Olinger K et al (2014) Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol 25:933–939CrossRefPubMed

18.

Charles HW, Black M, Kovacs S et al (2009) G2 inferior vena cava filter: retrievability and safety. J Vasc Interv Radiol 20:1046–1051CrossRefPubMed

19.

Doody O, Given MF, Kavnoudias H et al (2009) Initial experience in 115 patients with the retrievable Cook Celect vena cava filter. J Med Imaging Radiat Oncol 53:64–68CrossRefPubMed

20.

Hoppe H, Nutting CW, Smouse HR et al (2006) Gunther Tulip filter retrievability multicenter study including CT follow-up: final report. J Vasc Interv Radiol 17:1017–1023CrossRefPubMed

21.

Dixon A, Stavropoulos SW (2013) Improving retrieval rates for retrievable inferior vena cava filters. Expert Rev Med Devices 10:135–141CrossRefPubMed

22.

Binkert CA, Bansal A, Gates JD (2005) Inferior vena cava filter removal after 317-day implantation. J Vasc Interv Radiol 16:395–398CrossRefPubMed

23.

McConville RM, Kennedy PT, Collins AJ et al (2009) Failed retrieval of an inferior vena cava filter during pregnancy because of filter tilt: report of two cases. Cardiovasc Intervent Radiol 32:174–177CrossRefPubMed

24.

Turba UC, Arslan B, Meuse M et al (2010) Gunter tulip filter retrieval experience: predictors of successful retrieval. Cardiovasc Intervent Radiol 33:732–738CrossRefPubMed

25.

Looby S, Given MF, Geoghegan T et al (2007) Gunther Tulip retrievable inferior vena caval filters: indications, efficacy, retrieval, and complications. Cardiovasc Intervent Radiol 30:59–65CrossRefPubMed

26.

Zhu X, Tam MD, Bartholomew J et al (2011) Retrievability and device-related complications of the G2 filter: a retrospective study of 139 filter retrievals. J Vasc Interv Radiol 22:806–812CrossRefPubMed

27.

Lee JK, So YH, Choi YH et al (2014) Clinical course and predictive factors for complication of inferior vena cava filters. Thromb Res 133:538–543CrossRefPubMed

28.

Bogue CO, John PR, Connolly BL et al (2009) Symptomatic caval penetration by a Celect inferior vena cava filter. Pediatr Radiol 39:1110–1113CrossRefPubMed

29.

Oh JC, Trerotola SO, Dagli M et al (2011) Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall. J Vasc Interv Radiol 22:70–74CrossRefPubMed

30.

Hull JE, Han J, Giessel GM (2008) Retrieval of the recovery filter after arm perforation, fracture, and migration to the right ventricle. J Vasc Interv Radiol 19:1107–1111CrossRefPubMed

31.

Hull JE, Robertson SW (2009) Bard Recovery filter: evaluation and management of vena cava limb perforation, fracture, and migration. J Vasc Interv Radiol 20:52–60CrossRefPubMed

32.

Nathani N, Barzallo M, Mungee S (2010) Myopericarditis secondary to embolization of fractured inferior vena cava filter limbs. J Invasive Cardiol 22:E225–E228PubMed

33.

Chandra PA, Nwokolo C, Chuprun D et al (2008) Cardiac tamponade caused by fracture and migration of inferior vena cava filter. South Med J 101:1163–1164CrossRefPubMed

34.

Vink TW, Reekers JA, Van Dijk LC et al (2012) Balloon-assisted retrieval of tilted OptEase IVC filter. Cardiovasc Intervent Radiol 35:975–977CrossRefPubMed

35.

Van Ha TG, Vinokur O, Lorenz J et al (2009) Techniques used for difficult retrievals of the Gunther Tulip inferior vena cava filter: experience in 32 patients. J Vasc Interv Radiol 20:92–99CrossRefPubMed

36.

Lynch FC (2009) Balloon-assisted removal of tilted inferior vena cava filters with embedded tips. J Vasc Interv Radiol 20:1210–1214CrossRefPubMed

37.

Stavropoulos SW, Dixon RG, Burke CT et al (2008) Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol 19:1297–1301CrossRefPubMed

38.

Dinglasan LA, Trerotola SO, Shlansky-Goldberg RD et al (2012) Removal of fractured inferior vena cava filters: feasibility and outcomes. J Vasc Interv Radiol 23:181–187CrossRefPubMed

39.

Kuo WT, Deso SE, Robertson SW (2013) Vena Tech LGM filter retrieval 16 years after implantation: piecemeal removal by intentional mechanical fracture. J Vasc Interv Radiol 24:1731–1737CrossRefPubMed

40.

Kuo WT, Odegaard JI, Louie JD et al (2011) Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study. J Vasc Interv Radiol 22:813–823CrossRefPubMed

41.

Esparaz AM, Ryu RK, Gupta R et al (2012) Fibrin cap disruption: an adjunctive technique for inferior vena cava filter retrieval. J Vasc Interv Radiol 23:1233–1235CrossRefPubMed

Title: IVC filter retrieval in adolescents: experience in a tertiary pediatric center
Authors: Anthony K. Guzman
Mahmoud Zahra
Scott O. Trerotola
Leslie J. Raffini
Maxim Itkin
Marc S. Keller
Anne Marie Cahill
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 4/2016
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-015-3519-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

IVC filter retrieval in adolescents: experience in a tertiary pediatric center

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2016

Imaging findings of Hoffa’s fat pad herniation

CT cystography for evaluation of augmented bladder perforation: be safe and know the limitations

Candida albicans pancreatitis in a child with cystic fibrosis post lung transplantation

Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease

MR enterography–histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis?

CT cystography for evaluation of bladder perforation––be safe and know the limitations––reply to Dr. Karmazyn