Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration
- 250 Downloads
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.
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.
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.
KeywordsVena cava filter Deep vein thrombosis Valsalva maneuver Complications Penetration
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.
- 3.Kuo WT, Robertson SW, Odegaard JI, Hofmann LV (2013) Complex retrieval of fractured, embedded, and penetrating inferior vena cava filters: a prospective study with histologic and electron microscopic analysis. J Vasc Interv Radiol 24(5):622.e1–630.e1. doi:10.1016/j.jvir.2013.01.008 quiz 631CrossRefGoogle Scholar
- 4.Oh JC, Trerotola SO, Dagli M, Shlansky-Goldberg RD, Soulen MC, Itkin 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(1):70–74. doi:10.1016/j.jvir.2010.09.021 CrossRefPubMedGoogle Scholar
- 10.Caplin DM, Nikolic B, Kalva SP, Ganguli S, Saad WE, Zuckerman DA, Society of Interventional Radiology Standards of Practice Committee (2011) Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol 22(11):1499–1506. doi:10.1016/j.jvir.2011.07.012 PubMedGoogle Scholar
- 15.Durack JC, Westphalen AC, Kekulawela S, Bhanu SB, Avrin DE, Gordon RL et al (2012) Perforation of the IVC: rule rather tan exception after longer indwelling times for the Gunther Tulip and Celect retrievable filters. Cardiovasc Intervent Radiol 35(2):299–308. doi:10.1007/s00270-011-0151-9 CrossRefPubMedGoogle Scholar
- 17.Olorunsola OG, Kohi MP, Fidelman N, Westphalen AC, Kolli PK, Taylor AG et al (2013) Caval penetration by retrievable inferior vena cava filters: a retrospective comparison of Option and Günther Tulip filters. J Vasc Interv Radiol 24(4):566–571. doi:10.1016/j.jvir.2012.12.024 CrossRefPubMedGoogle Scholar
- 24.US Department of Health and Human Services; US Food and Drug Administration. Removing Retrievable Inferior Vena Cava Filters: FDA Safety Communication. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm. Accessed Nov 1 2014