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Inferior vena cava interruption with the Hunter-Sessions balloon: eighteen years' experience in 191 cases
J A Hunter1, G A DeLaria, M D Goldin
1Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
Insights
The Hunter-Sessions balloon effectively prevented pulmonary embolism in high-risk patients over 18 years. This inferior vena cava interruption device demonstrated no migration or malfunction, improving leg edema post-procedure.
Area of Science:
- Vascular Surgery
- Cardiology
- Pulmonary Medicine
Background:
- Deep venous thrombosis (DVT) and pulmonary embolism (PE) pose significant risks, especially in patients with contraindications or complications from anticoagulation.
- Inferior vena cava (IVC) interruption is a critical intervention for preventing PE in select patient populations.
- The Hunter-Sessions balloon is a device used for IVC interruption.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the Hunter-Sessions balloon for IVC interruption in patients with DVT and PE.
- To assess the incidence of PE, mortality, and long-term outcomes following IVC interruption with the Hunter-Sessions balloon.
Main Methods:
- A retrospective review of 191 consecutive patients undergoing IVC interruption with the Hunter-Sessions balloon over 18 years.
- Data collection included patient demographics, indications for IVC interruption, procedural details, in-hospital outcomes, and long-term follow-up.
- Diagnostic methods for PE included ventilation-perfusion scanning, angiography, and clinical assessment.
Main Results:
- 165 patients (86%) had a history of PE; 52% were in significant cardiopulmonary distress at the time of procedure.
- No patient experienced PE while in the hospital after Hunter-Sessions balloon insertion; no in-hospital deaths were related to the procedure.
- Long-term follow-up showed no device malfunction or migration, with 75% of patients free of leg edema and no late deaths attributed to PE.
Conclusions:
- The Hunter-Sessions balloon is a safe and effective method for IVC interruption in patients at high risk for PE.
- The device successfully prevented PE in the peri-procedural period and demonstrated favorable long-term outcomes regarding leg edema and device integrity.
- IVC interruption with the Hunter-Sessions balloon offers a viable alternative for patients with contraindications or complications related to anticoagulation therapy.
Abstract:
Over a period of 18 years, 191 consecutive patients had interruption of the inferior vena cava with the Hunter-Sessions balloon for complications of deep venous thrombosis and pulmonary embolism. Causes of deep venous thrombosis and pulmonary embolism included the postoperative state (33%), cancer (32%), and stroke (11%). There were 93 females and 98 males; ages ranged from 17 to 90 years (average, 57 years). Indications for placement of the Hunter-Sessions balloon were as follows: contraindication to anticoagulants (33%), anticoagulant complications (24%), pulmonary embolism despite anticoagulants (45%), and others including inferior vena cava thrombus (12%). Sixty-eight percent had clinical phlebitis and 36% had positive venography results. Pulmonary embolism had occurred in 165 patients (86%). It was diagnosed by ventilation-perfusion scanning (75%), angiography (23%), or on clinical grounds (2%) in patients with confirmed deep venous thrombosis. At the time of the procedure 52% were in significant cardiopulmonary distress, and 10% were intubated and on respirators. Transjugular placement was done in 188 patients, and transfemoral placement was performed in three. All All tolerated inferior vena cava interruption. Thirty patients (15%) died while in the hospital an average of 21 days after balloon placement, which was unrelated to the deaths. Follow-up was 45 months. Ninety-four patients are dead, 95 are alive, and the status of two patients is unknown. Twenty-nine of 64 patients (45%) who died after they left the hospital died of cancer. At last follow-up, 75% of patients had legs free of edema and 25% had need for elastic stockings. No malfunction or migration has occurred with the device. No patient had a pulmonary embolism while in the hospital after insertion of the Hunter-Sessions balloon, and no patient died of pulmonary embolism. Late minor pulmonary embolism occurred in three patients.