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Erschienen in: Pediatric Radiology 4/2016

21.01.2016 | Original Article

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

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

Erschienen in: Pediatric Radiology | Ausgabe 4/2016

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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.
Literatur
1.
Zurück zum Zitat Chalmers EA (2006) Epidemiology of venous thromboembolism in neonates and children. Thromb Res 118:3–12CrossRefPubMed Chalmers EA (2006) Epidemiology of venous thromboembolism in neonates and children. Thromb Res 118:3–12CrossRefPubMed
2.
Zurück zum Zitat Johnson C, Alomari AI, Chaudry G (2011) Detachment of introducer sheath radiopaque marker during retrieval of G2 filter. Cardiovasc Intervent Radiol 34:431–434CrossRefPubMed Johnson C, Alomari AI, Chaudry G (2011) Detachment of introducer sheath radiopaque marker during retrieval of G2 filter. Cardiovasc Intervent Radiol 34:431–434CrossRefPubMed
3.
Zurück zum Zitat Raffini L, Cahill AM, Hellinger J (2008) A prospective observational study of IVC filters in pediatric patients. Pediatr Blood Cancer 51:517–520 Raffini L, Cahill AM, Hellinger J (2008) A prospective observational study of IVC filters in pediatric patients. Pediatr Blood Cancer 51:517–520
4.
Zurück zum Zitat Takemoto CM, Sohi S, Desai K et al (2014) Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 164:332–338CrossRefPubMed Takemoto CM, Sohi S, Desai K et al (2014) Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr 164:332–338CrossRefPubMed
5.
Zurück zum Zitat 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 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
6.
Zurück zum Zitat 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 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
7.
Zurück zum Zitat 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 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
8.
Zurück zum Zitat Chaudry G, Padua HM, Alomari AI (2008) The use of inferior vena cava filters in young children. J Vasc Interv Radiol 19:1103–1106CrossRefPubMed Chaudry G, Padua HM, Alomari AI (2008) The use of inferior vena cava filters in young children. J Vasc Interv Radiol 19:1103–1106CrossRefPubMed
9.
Zurück zum Zitat Sridhar AV, Rao NK, Chakraborty S (2005) A six-year old with fatal pulmonary embolism. Acta Paediatr 94:977–979CrossRefPubMed Sridhar AV, Rao NK, Chakraborty S (2005) A six-year old with fatal pulmonary embolism. Acta Paediatr 94:977–979CrossRefPubMed
10.
Zurück zum Zitat Gunta S, Kamath S (2012) A case of pulmonary embolism and stroke in a 16-year-old girl. WMJ 111:58–60PubMed Gunta S, Kamath S (2012) A case of pulmonary embolism and stroke in a 16-year-old girl. WMJ 111:58–60PubMed
11.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Rimon U, Bensaid P, Golan G et al (2011) Optease vena cava filter optimal indwelling time and retrievability. Cardiovasc Intervent Radiol 34:532–535CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Charles HW, Black M, Kovacs S et al (2009) G2 inferior vena cava filter: retrievability and safety. J Vasc Interv Radiol 20:1046–1051CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Dixon A, Stavropoulos SW (2013) Improving retrieval rates for retrievable inferior vena cava filters. Expert Rev Med Devices 10:135–141CrossRefPubMed Dixon A, Stavropoulos SW (2013) Improving retrieval rates for retrievable inferior vena cava filters. Expert Rev Med Devices 10:135–141CrossRefPubMed
22.
Zurück zum Zitat Binkert CA, Bansal A, Gates JD (2005) Inferior vena cava filter removal after 317-day implantation. J Vasc Interv Radiol 16:395–398CrossRefPubMed Binkert CA, Bansal A, Gates JD (2005) Inferior vena cava filter removal after 317-day implantation. J Vasc Interv Radiol 16:395–398CrossRefPubMed
23.
Zurück zum Zitat 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 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.
Zurück zum Zitat Turba UC, Arslan B, Meuse M et al (2010) Gunter tulip filter retrieval experience: predictors of successful retrieval. Cardiovasc Intervent Radiol 33:732–738CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Bogue CO, John PR, Connolly BL et al (2009) Symptomatic caval penetration by a Celect inferior vena cava filter. Pediatr Radiol 39:1110–1113CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Nathani N, Barzallo M, Mungee S (2010) Myopericarditis secondary to embolization of fractured inferior vena cava filter limbs. J Invasive Cardiol 22:E225–E228PubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Vink TW, Reekers JA, Van Dijk LC et al (2012) Balloon-assisted retrieval of tilted OptEase IVC filter. Cardiovasc Intervent Radiol 35:975–977CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Lynch FC (2009) Balloon-assisted removal of tilted inferior vena cava filters with embedded tips. J Vasc Interv Radiol 20:1210–1214CrossRefPubMed Lynch FC (2009) Balloon-assisted removal of tilted inferior vena cava filters with embedded tips. J Vasc Interv Radiol 20:1210–1214CrossRefPubMed
37.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
Metadaten
Titel
IVC filter retrieval in adolescents: experience in a tertiary pediatric center
verfasst von
Anthony K. Guzman
Mahmoud Zahra
Scott O. Trerotola
Leslie J. Raffini
Maxim Itkin
Marc S. Keller
Anne Marie Cahill
Publikationsdatum
21.01.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Radiology / Ausgabe 4/2016
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-015-3519-1

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