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Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration

  • Clinical Investigation
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Abstract

Purpose

The purpose of the study is to evaluate the influence of respiratory-induced vena caval hemodynamic changes on filter migration/penetration.

Materials and Methods

After placement of either a Gunther Tulip or Celect IVC filter, 101 consecutive patients scheduled for filter retrieval were prospectively enrolled in this study. Pre-retrieval CT scans were used to assess filter complications and to calculate cross-sectional area in three locations: at level of filter strut fixation, 3 cm above and 3 cm below. A 3D finite element simulation was constructed on these data and direct IVC pressure was recorded during filter retrieval. Cross-sectional areas and pressures of the vena cava were measured during neutral breathing and in Valsalva maneuver and identified filter complications were recorded. A statistical analysis of these variables was then performed.

Results

During Valsalva maneuvers, a 60 % decrease of the IVC cross-sectional area and a fivefold increase in the IVC pressure were identified (p < 0.001). There was a statistically significant difference in the reduction of the cross-sectional area at the filter strut level (p < 0.001) in patient with filter penetration. Difficulty in filter retrieval was higher in penetrated or tilted filters (p < 0.001; p = 0.005). 3D computational models showed significant IVC deformation around the filter during Valsalva maneuver.

Conclusion

Caval morphology and hemodynamics are clearly affected by Valsalva maneuvers. A physiological reduction of IVC cross-sectional area is associated with higher risk of filter penetration, despite short dwell times. Physiologic data should be used to improve future filter designs to remain safely implanted over longer dwell times.

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Conflict of interest

Alicia Laborda, William T. Kuo, Ignatios Ioakeim, Ignacio de Blas, Mauro Malvè, Celia Lahuerta and Miguel A. De Gregorio declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Minimally Invasive Techniques Research Group (GITMI), Universidad de Zaragoza, Miguel Servet, 177, 50013, Saragossa, Spain

    Alicia Laborda, Ignatios Ioakeim, Celia Lahuerta & Miguel A. De Gregorio

  2. Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA, 94305-5642, USA

    William T. Kuo

  3. Unit of Infectious Diseases and Epidemiology, Department of Animal Pathology, Universidad de Zaragoza, Calle Miguel Servet, 177, 50013, Saragossa, Spain

    Ignacio De Blas

  4. Department of Mechanical, Energy and Materials Engineering, Universidad Pública de Navarra, Campus Arrosadía, Edif. de los Pinos, 31006, Pamplona, Spain

    Mauro Malvè

  5. CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Saragossa, Spain

    Mauro Malvè & Miguel A. De Gregorio

Authors
  1. Alicia Laborda
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  2. William T. Kuo
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  3. Ignatios Ioakeim
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  4. Ignacio De Blas
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  5. Mauro Malvè
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  6. Celia Lahuerta
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  7. Miguel A. De Gregorio
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Correspondence to Alicia Laborda.

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Laborda, A., Kuo, W.T., Ioakeim, I. et al. Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration. Cardiovasc Intervent Radiol 38, 1192–1197 (2015). https://doi.org/10.1007/s00270-015-1077-4

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  • DOI: https://doi.org/10.1007/s00270-015-1077-4

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