Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?: An Analysis in 762 Procedures

Kush R Desai, James L. Laws, Riad Salem, Samdeep K Mouli, Martin F. Errea, Jennifer K. Karp, Yihe Yang, Robert K. Ryu, Robert J Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background - Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results - From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P<0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). Conclusions - The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.

Original languageEnglish (US)
Article numbere003957
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Vena Cava Filters
Referral and Consultation
Logistic Models
Odds Ratio
Regression Analysis
Databases
Confidence Intervals

Keywords

  • humans
  • pulmonary embolism
  • risk factors
  • vena cava filters
  • venous thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{68f312e15eb34cdebfdd7558c00c4031,
title = "Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?: An Analysis in 762 Procedures",
abstract = "Background - Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results - From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98{\%} (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18{\%} of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95{\%} confidence interval, 1.05-1.10; P<0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9{\%}. Adverse events occurred at a rate of 2{\%} (n=18; 15 minor and 3 major). Conclusions - The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.",
keywords = "humans, pulmonary embolism, risk factors, vena cava filters, venous thrombosis",
author = "Desai, {Kush R} and Laws, {James L.} and Riad Salem and Mouli, {Samdeep K} and Errea, {Martin F.} and Karp, {Jennifer K.} and Yihe Yang and Ryu, {Robert K.} and Lewandowski, {Robert J}",
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Defining Prolonged Dwell Time : When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?: An Analysis in 762 Procedures. / Desai, Kush R; Laws, James L.; Salem, Riad; Mouli, Samdeep K; Errea, Martin F.; Karp, Jennifer K.; Yang, Yihe; Ryu, Robert K.; Lewandowski, Robert J.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 6, e003957, 01.06.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Defining Prolonged Dwell Time

T2 - When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?: An Analysis in 762 Procedures

AU - Desai, Kush R

AU - Laws, James L.

AU - Salem, Riad

AU - Mouli, Samdeep K

AU - Errea, Martin F.

AU - Karp, Jennifer K.

AU - Yang, Yihe

AU - Ryu, Robert K.

AU - Lewandowski, Robert J

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background - Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results - From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P<0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). Conclusions - The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.

AB - Background - Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results - From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P<0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). Conclusions - The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.

KW - humans

KW - pulmonary embolism

KW - risk factors

KW - vena cava filters

KW - venous thrombosis

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DO - 10.1161/CIRCINTERVENTIONS.116.003957

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