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Complicated inferior vena cava filter retrievals: associated factors identified at preretrieval CT
Lu Anne V Dinglasan1, John C Oh, J Eric Schmitt
1Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19010, USA.
Insights
Preretrieval CT reveals characteristics like tip embedding and increased tilt angle that predict complicated inferior vena cava (IVC) filter retrieval. Identifying these factors can help tailor the retrieval approach for better patient outcomes.
Area of Science:
- Radiology
- Interventional Radiology
- Medical Imaging
Background:
- Inferior vena cava (IVC) filters are used to prevent pulmonary embolism.
- Retrieval of IVC filters can sometimes be complicated.
- Predicting retrieval difficulty before the procedure is crucial for patient safety.
Purpose of the Study:
- To identify pre-retrieval computed tomography (CT) characteristics associated with complicated IVC filter retrieval.
- To correlate specific CT findings with the likelihood of a difficult filter removal.
Main Methods:
- Retrospective review of 96 IVC filter retrievals (48 complicated, 48 uncomplicated).
- Analysis of pre-retrieval CT scans for filter tilt, tip embedding, strut perforation, and distance from renal veins.
- Comparison of dwell time and statistical analysis including multivariate logistic regression.
Main Results:
- Complicated retrievals showed higher tilt angles, greater perforation, and longer dwell times.
- CT appearance of tip embedding significantly increased the odds of a complicated retrieval (129-fold).
- Tilt angle >15° (33-fold odds), perforation (10.7-fold odds), and dwell time (2.3-fold odds) also correlated with difficulty.
Conclusions:
- Pre-retrieval CT findings such as tip embedding, increased tilt, perforation, and dwell time predict complicated IVC filter retrieval.
- Utilizing pre-retrieval CT can help identify patients at higher risk for retrieval complications.
- This information may guide procedural planning and referral to specialized centers when necessary.
Purpose:
To examine filter characteristics at preretrieval computed tomography (CT) that are associated with complicated inferior vena cava (IVC) filter retrieval procedures.
Materials And Methods:
This study was HIPAA compliant, and informed consent was waived. Institutional review board-approved retrospective review of IVC filter retrievals between January 2002 and July 2011 was performed to identify patients with preretrieval CT in whom a complicated retrieval was performed, as defined by use of nonstandard techniques, filter fracture, filter tip incorporation into the IVC wall, and retrieval failure. Age- and sex-matched control subjects with standard IVC filter retrieval were used for comparison. Preretrieval CT images were evaluated for tilt angle in mediolateral and anteroposterior directions, CT appearance of tip embedding, degree of filter strut perforation, and distance of filter tip from the nearest renal vein. Dwell time was also recorded. Statistical analysis was performed by using the Fisher exact test, Student t test, and Wilcoxon signed-rank test, depending on the variables being evaluated, as well as multivariate logistic regression.
Results:
Forty-eight patients with complicated retrievals and 48 control subjects with uncomplicated retrievals were evaluable for preretrieval CT characteristics. Mediolateral and anteroposterior tilt angle, degree of perforation, and dwell time were higher for the complicated versus non-complicated retrieval group (P < .01). Odds of complicated retrieval were increased 129-fold with CT appearance of tip embedding (P < .0001), with an odds ratio of 33 with a tilt angle of more than 15° in any direction (P < .0001), while perforation and dwell time increased risk of a complicated retrieval by 10.7 (P < .0001) and 2.3 (P < .05) times, respectively. Distance from renal veins was noncontributory.
Conclusion:
CT appearance of tip embedding, increased tilt angle, higher-grade perforation, and longer dwell times are associated with complicated IVC filter retrieval. Therefore, preretrieval CT may be warranted in select patients for identification of these characteristics to tailor retrieval approach or to arrange a referral to a tertiary center if necessary.
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