[Caval interruption operations for prevention of lung embolism]

Area of Science:

• Vascular Surgery
• Cardiology
• Interventional Radiology

Background:

• Inferior vena cava (IVC) interruption is a critical procedure for preventing pulmonary embolism.
• Various devices like umbrella-filters, clips, and Greenfield filters have been used over 14 years.
• Patient selection is crucial, reserved for those with recurrent pulmonary embolism despite anticoagulation or when thrombectomy is contraindicated.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of different IVC interruption devices.
• To compare the patency rates and mortality associated with various IVC filters.
• To assess the impact of IVC interruption on venous hemodynamics.

Main Methods:

• Retrospective analysis of over 400 patients undergoing IVC interruption over 14 years.
• Assessment of hospital mortality based on the device used (clip vs. Mobin-Uddin umbrella).
• Objective evaluation of IVC patency in 121 patients using cavography.
• Venous status assessment in 45 patients via intracaval pressure measurements.

Main Results:

• Overall hospital mortality was 1% for clip application and 7% for Mobin-Uddin umbrellas.
• IVC patency rates were significantly higher with Greenfield filters (95%) and clips compared to Mobin-Uddin devices (15%).
• Intracaval pressure measurements confirmed venous status post-intervention.

Conclusions:

• Greenfield filters and clips offer superior long-term IVC patency compared to Mobin-Uddin devices.
• IVC interruption with clips demonstrates a low hospital mortality rate.
• These findings support the use of specific IVC filters for managing recurrent pulmonary embolism.