CardioVascular and Interventional Radiology

, Volume 35, Issue 2, pp 299–308

Perforation of the IVC: Rule Rather Than Exception After Longer Indwelling Times for the Günther Tulip and Celect Retrievable Filters

Authors

    • Department of Radiology and Biomedical ImagingUniversity of California
  • Antonio C. Westphalen
    • Department of Radiology and Biomedical ImagingUniversity of California
  • Stephanie Kekulawela
    • Department of SurgeryPenn State Milton S. Hershey Medical Center
  • Shiv B. Bhanu
    • University of California, San Francisco School of Medicine
  • David E. Avrin
    • Department of Radiology and Biomedical ImagingUniversity of California
  • Roy L. Gordon
    • Department of Radiology and Biomedical ImagingUniversity of California
  • Robert K. Kerlan
    • Department of Radiology and Biomedical ImagingUniversity of California
Clinical Investigation

DOI: 10.1007/s00270-011-0151-9

Cite this article as:
Durack, J.C., Westphalen, A.C., Kekulawela, S. et al. Cardiovasc Intervent Radiol (2012) 35: 299. doi:10.1007/s00270-011-0151-9

Abstract

Purpose

This study was designed to assess the incidence, magnitude, and impact upon retrievability of vena caval perforation by Günther Tulip and Celect conical inferior vena cava (IVC) filters on computed tomographic (CT) imaging.

Methods

Günther Tulip and Celect IVC filters placed between July 2007 and May 2009 were identified from medical records. Of 272 IVC filters placed, 50 (23 Günther Tulip, 46%; 27 Celect, 54%) were retrospectively assessed on follow-up abdominal CT scans performed for reasons unrelated to the filter. Computed tomography scans were examined for evidence of filter perforation through the vena caval wall, tilt, or pericaval tissue injury. Procedure records were reviewed to determine whether IVC filter retrieval was attempted and successful.

Results

Perforation of at least one filter component through the IVC was observed in 43 of 50 (86%) filters on CT scans obtained between 1 and 880 days after filter placement. All filters imaged after 71 days showed some degree of vena caval perforation, often as a progressive process. Filter tilt was seen in 20 of 50 (40%) filters, and all tilted filters also demonstrated vena caval perforation. Transjugular removal was attempted in 12 of 50 (24%) filters and was successful in 11 of 12 (92%).

Conclusions

Longer indwelling times usually result in vena caval perforation by retrievable Günther Tulip and Celect IVC filters. Although infrequently reported in the literature, clinical sequelae from IVC filter components breaching the vena cava can be significant. We advocate filter retrieval as early as clinically indicated and increased attention to the appearance of IVC filters on all follow-up imaging studies.

Keywords

Pulmonary thromboembolismIVC filter perforationCelectGünther Tulip

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011