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[Remote results of implantation of cava filters: analysis of errors and complications]
I I Zatevakhin1, V N Shipovsky1, M A Barzaeva1
1Surgical Diseases Department No1, Russian National Research Medical University named after N.I. Pirogov, Municipal Clinical Hospital No57, Moscow, Russia.
Insights
This study compared cava filters (CF) for preventing pulmonary artery thromboembolism in patients with iliofemoral thrombosis. Complication rates varied by filter type, with some filters showing higher risks of vena cava occlusion.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Inferior vena cava filters (IVCFs) are used to prevent pulmonary embolism (PE) in patients with deep vein thrombosis (DVT).
- Long-term outcomes and complications associated with different IVCF types require further investigation.
Purpose of the Study:
- To comparatively assess the efficacy of various cava filters (CF) in preventing pulmonary artery thromboembolism (PATE).
- To analyze complications in the remote postimplantation period of CFs.
Main Methods:
- A comparative study of 266 patients implanted with different types of cava filters (one-level, two-level, "TrapEase"/"OptEase").
- Follow-up duration ranged from 1 month to 10 years post-implantation.
- Assessment of relapsed PATE, CF embolism, and inferior vena cava (IVC) occlusion.
Main Results:
- Relapsed PATE occurred in 5.2% of cases; CF embolism in 9.3%, independent of filter type.
- Total IVC occlusion was 2x more frequent with two-level and "TrapEase"/"OptEase" filters.
- Chronic IVC occlusion occurred in 13.9%, most often with two-level filters; IVC syndrome was diagnosed in 24.1% with lower thrombus levels.
Conclusions:
- While CFs are effective in preventing PATE, complication rates vary by filter type.
- Two-level and "TrapEase"/"OptEase" filters are associated with higher risks of IVC occlusion.
- Implantation technique and filter characteristics influence long-term IVC patency and complication development.
Abstract:
The authors carried out comparative assessment of efficacy of cava filters (CF) for prevention of pulmonary artery thromboembolism in patients presenting with iliofemoral thrombosis with flotation of thrombi, as well as analysed complications in the remote postimplantation period. A total of 266 patients were examined within the terms from 1 month to 10 years after CF implantation. Depending on the type of the implanted device, all patients were subdivided into 3 groups: group 1 (n=65) consisted of patients with one-level CF, group 2 (n=112) comprised those with "sandglass" and "shuttle" type two-level cava filters, and group 3 (n=89) was composed of patients with the implanted CF "TrapEase" and "OptEase". In the remote period relapsed PATE was revealed in 5.2% of cases. Embolism in the CF was noted in 9.3% of cases, with the incidence rate of this complication not depending on the type of the implanted device. However, total occlusion of the inferior vena cava after embolism was observed 2 times more often in patients of the 2nd and 3rd group. In the first group recanalization of the intrafilter space occurred in one third of cases. Chronic occlusion of the inferior vena cava was revealed in 13.9% of cases, most frequently in group 2. Total occlusion of the inferior vena cava with the development of inferior vena cava syndrome was diagnosed in 24.1% of patients with thrombotic lesion below the level of renal veins confluence. This complication was associated with both characteristics of CF and technical errors of implantation, and was also encountered more frequently in group 2.
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