CardioVascular and Interventional Radiology

, Volume 38, Issue 5, pp 1192–1197 | Cite as

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

  • Alicia Laborda
  • William T. Kuo
  • Ignatios Ioakeim
  • Ignacio De Blas
  • Mauro Malvè
  • Celia Lahuerta
  • Miguel A. De Gregorio
Clinical Investigation



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.


Vena 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.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Alicia Laborda
    • 1
  • William T. Kuo
    • 2
  • Ignatios Ioakeim
    • 1
  • Ignacio De Blas
    • 3
  • Mauro Malvè
    • 4
    • 5
  • Celia Lahuerta
    • 1
  • Miguel A. De Gregorio
    • 1
    • 5
  1. 1.Minimally Invasive Techniques Research Group (GITMI)Universidad de ZaragozaSaragossaSpain
  2. 2.Division of Vascular and Interventional RadiologyStanford University Medical CenterStanfordUSA
  3. 3.Unit of Infectious Diseases and Epidemiology, Department of Animal PathologyUniversidad de ZaragozaSaragossaSpain
  4. 4.Department of Mechanical, Energy and Materials EngineeringUniversidad Pública de NavarraPamplonaSpain
  5. 5.CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)SaragossaSpain

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