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[Total laparoscopic retrieval of a cava filter: case series]
P V Mozgovoĭ1, E N Ziubina1, E G Spiridonov1
1Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia.
Insights
When endovascular retrieval fails, total laparoscopic retrieval of a vena cava filter is a safe, minimally invasive option. This approach avoids complications and conversion to open surgery.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Anticoagulant therapy is standard for venous thromboembolic complications.
- Cava filter placement is indicated when anticoagulation is contraindicated, ineffective, or causes complications.
- Retrieval of vena cava filters carries risks of complications.
Purpose of the Study:
- To evaluate the safety and efficacy of total laparoscopic retrieval of vena cava filters after failed endovascular attempts.
- To present a case series of patients managed with this technique.
Main Methods:
- Analysis of 4 patients treated between February 2015 and March 2017.
- Patients underwent total laparoscopic retrieval of the vena cava filter due to unsuccessful endovascular retrieval.
- Procedure included phlebotomy, filter retrieval, and phlebectomy zone suturing.
Main Results:
- Laparoscopic retrieval was successful in all 4 patients.
- Procedure time ranged from 32 to 45 minutes.
- Maximum blood loss was 300 ml, without need for transfusion.
- No conversion to laparotomy was required.
- No significant systemic or wound complications were observed postoperatively.
Conclusions:
- Total laparoscopic retrieval is a relatively safe and minimally invasive option for vena cava filters when endovascular retrieval fails.
- This method is suitable for experienced surgical teams skilled in laparoscopic and angiosurgical procedures.
Abstract:
Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.
