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Gunther Tulip Filter Strut Penetration: Benign Long-Term Follow-up.

Eric K Hoffer1, Rebecca J Mueller1, Nicole N Lee1

  • 1Section of Interventional Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.

Journal of Vascular and Interventional Radiology : JVIR
|May 16, 2023
PubMed
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Gunther Tulip filter (GTF) struts commonly penetrate the inferior vena cava, but penetration typically plateaus by 10 years. Asymptomatic strut penetration can be managed non-interventionally due to limited progression and low complication rates.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Medical Imaging

Background:

  • Inferior vena cava filters (IVCFs) are used to prevent pulmonary embolism in patients with venous thromboembolism.
  • The Gunther Tulip filter (GTF) is a retrievable IVCF, and strut penetration is a known potential complication.
  • Understanding the natural history of GTF strut penetration is crucial for clinical management.

Purpose of the Study:

  • To describe the natural history of Gunther Tulip filter (GTF) strut penetration.
  • To correlate strut penetration distance with filter dwell time and patient demographics.
  • To assess clinical manifestations associated with GTF strut penetration.

Main Methods:

  • Retrospective review of 203 patients who underwent infrarenal GTF placement.

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  • Computed tomography (CT) scans were used to measure strut penetration distance from the outer caval wall.
  • A linear mixed model was employed to analyze filter strut behavior over time.

    • Main Results:

    • Strut penetration correlated positively with filter dwell time, plateauing at 3.3 mm by 10 years.
    • At median 4.7-year follow-up, 79.3% of patients had struts >0.2 mm penetration, and 31% had struts >3 mm.
    • Strut penetration was greater in women; 52.7% of filters had strut abutment or entry into adjacent structures, with no symptomatic complications reported.

    Conclusions:

    • Gunther Tulip filter struts frequently penetrate the inferior vena cava progressively, but this progression tends to stabilize by 10 years.
    • The limited long-term progression and very low incidence of symptomatic complications support a non-interventional approach for asymptomatic strut penetration.
    • This finding guides clinical decision-making regarding the management of incidental GTF strut penetration on imaging.