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Vena cava filter performance based on hemodynamics and reported thrombosis and pulmonary embolism patterns
Aneal Harlal1, Matadial Ojha, K Wayne Johnston
1Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada.
Journal of Vascular and Interventional Radiology : JVIR
|February 14, 2007
Summary
Inferior vena cava (IVC) filters with flow stagnation, like Mobin-Uddin and TrapEase, showed higher thrombosis and pulmonary embolism (PE) rates. The Greenfield filter, without these issues, had better clinical outcomes.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Device Analysis
Background:
- Inferior vena cava (IVC) filters are crucial for preventing pulmonary embolism (PE).
- Understanding filter hemodynamics is key to improving clinical safety and efficacy.
- Previous studies suggest a link between filter design and adverse events like thrombosis.
Purpose of the Study:
- To correlate in vitro hemodynamic patterns of different IVC filter designs with clinical outcomes.
- To investigate the relationship between filter-induced blood flow disturbances and rates of thrombosis and recurrent PE.
- To compare the hemodynamic performance of Greenfield, TrapEase, and Mobin-Uddin filters.
Main Methods:
- In vitro photochromic flow visualization technique used to generate velocity contour maps for three IVC filter designs (Greenfield, TrapEase, Mobin-Uddin).
- Hemodynamic assessment conducted under both unoccluded and partially occluded filter states using steady flow (Reynolds number = 600).
- Analysis of published clinical studies and FDA databases to estimate IVC occlusion and recurrent PE rates over 30 years.
Main Results:
- Mobin-Uddin and TrapEase filters exhibited flow stagnation, recirculation, and turbulence downstream in both unoccluded and occluded states.
- The Greenfield filter demonstrated no prothrombotic flow patterns under tested conditions.
- Clinical data corroborated hemodynamic findings, showing higher IVC occlusion and PE rates for TrapEase and Mobin-Uddin compared to Greenfield.
Conclusions:
- Hemodynamic disturbances such as flow stagnation and turbulence are associated with increased thrombosis and PE.
- The observed hemodynamic differences explain the higher rates of filter thrombosis and PE associated with Mobin-Uddin and TrapEase filters compared to the Greenfield filter.
- These findings underscore the importance of filter design in mitigating risks of IVC filter-related complications.
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