Single-session inferior vena cava filter removal, recanalization, and endovenous reconstruction for chronic iliocaval thrombosis

Kush R Desai*, Nicholas Xiao, Jennifer Karp, Riad Salem, Heron Rodriguez Alvarez, Mark Eskandari, Omar M. Uddin, Robert J Lewandowski

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. Methods: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed. Inclusion criteria included computed tomography (CT) imaging and clinical presentations consistent with chronic (>30 days) IVCF-related chronic thrombosis. A retrospective analysis of technical success, clinical success as measured with the Venous Clinical Severity Score, use of advanced filter retrieval techniques, and AEs was performed. Primary patency was evaluated with CT at 1 to 3 months and 1 year. Data analysis was performed using a paired t-test. Results: There were 25 patients (median age, 58.0 years; standard deviation, 15.6 years) with eight types of IVCF encountered; all were treated in a single session. Technical success was achieved in all patients. Mean improvement in the Venous Clinical Severity Score was 1.4 (95% confidence interval, 1.0-1.7; P <.01) in the venous edema subscore and 0.6 (95% confidence interval, 0.2-1.0; P <.01) in the pain subscore. At 1 to 3 months, iliocaval stent patency was maintained in 96% of patients; unilateral iliac vein stent thrombus was seen in one patient. One-year follow-up was available in eight patients, with CT imaging demonstrating maintained patency. Median filter implantation time was 12.3 months (mean, 41.9 months; range, 0.8-245.1 months; standard deviation, 63.3 months). Advanced IVCF retrieval techniques were required for 17 procedures. One major AE and minor AE occurred; no patients died in the study period. Conclusions: Single-session iliocaval recanalization with IVCF retrieval has high rates of technical and clinical success in patients with IVCF-related chronic iliocaval thrombosis.

Original languageEnglish (US)
Pages (from-to)176-183
Number of pages8
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Volume7
Issue number2
DOIs
StatePublished - Mar 1 2019

Fingerprint

Vena Cava Filters
Thrombosis
Stents
Tomography
Confidence Intervals
Iliac Vein
Thrombectomy
Edema
Safety
Pain

Keywords

  • Chronic venous occlusion
  • IVC filters
  • Iliocaval thrombosis

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{0734c8b0b5fc447d8fff1a9e834185f0,
title = "Single-session inferior vena cava filter removal, recanalization, and endovenous reconstruction for chronic iliocaval thrombosis",
abstract = "Objective: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. Methods: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed. Inclusion criteria included computed tomography (CT) imaging and clinical presentations consistent with chronic (>30 days) IVCF-related chronic thrombosis. A retrospective analysis of technical success, clinical success as measured with the Venous Clinical Severity Score, use of advanced filter retrieval techniques, and AEs was performed. Primary patency was evaluated with CT at 1 to 3 months and 1 year. Data analysis was performed using a paired t-test. Results: There were 25 patients (median age, 58.0 years; standard deviation, 15.6 years) with eight types of IVCF encountered; all were treated in a single session. Technical success was achieved in all patients. Mean improvement in the Venous Clinical Severity Score was 1.4 (95{\%} confidence interval, 1.0-1.7; P <.01) in the venous edema subscore and 0.6 (95{\%} confidence interval, 0.2-1.0; P <.01) in the pain subscore. At 1 to 3 months, iliocaval stent patency was maintained in 96{\%} of patients; unilateral iliac vein stent thrombus was seen in one patient. One-year follow-up was available in eight patients, with CT imaging demonstrating maintained patency. Median filter implantation time was 12.3 months (mean, 41.9 months; range, 0.8-245.1 months; standard deviation, 63.3 months). Advanced IVCF retrieval techniques were required for 17 procedures. One major AE and minor AE occurred; no patients died in the study period. Conclusions: Single-session iliocaval recanalization with IVCF retrieval has high rates of technical and clinical success in patients with IVCF-related chronic iliocaval thrombosis.",
keywords = "Chronic venous occlusion, IVC filters, Iliocaval thrombosis",
author = "Desai, {Kush R} and Nicholas Xiao and Jennifer Karp and Riad Salem and {Rodriguez Alvarez}, Heron and Mark Eskandari and Uddin, {Omar M.} and Lewandowski, {Robert J}",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.jvsv.2018.10.014",
language = "English (US)",
volume = "7",
pages = "176--183",
journal = "Journal of Vascular Surgery: Venous and Lymphatic Disorders",
issn = "2213-333X",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Single-session inferior vena cava filter removal, recanalization, and endovenous reconstruction for chronic iliocaval thrombosis

AU - Desai, Kush R

AU - Xiao, Nicholas

AU - Karp, Jennifer

AU - Salem, Riad

AU - Rodriguez Alvarez, Heron

AU - Eskandari, Mark

AU - Uddin, Omar M.

AU - Lewandowski, Robert J

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objective: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. Methods: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed. Inclusion criteria included computed tomography (CT) imaging and clinical presentations consistent with chronic (>30 days) IVCF-related chronic thrombosis. A retrospective analysis of technical success, clinical success as measured with the Venous Clinical Severity Score, use of advanced filter retrieval techniques, and AEs was performed. Primary patency was evaluated with CT at 1 to 3 months and 1 year. Data analysis was performed using a paired t-test. Results: There were 25 patients (median age, 58.0 years; standard deviation, 15.6 years) with eight types of IVCF encountered; all were treated in a single session. Technical success was achieved in all patients. Mean improvement in the Venous Clinical Severity Score was 1.4 (95% confidence interval, 1.0-1.7; P <.01) in the venous edema subscore and 0.6 (95% confidence interval, 0.2-1.0; P <.01) in the pain subscore. At 1 to 3 months, iliocaval stent patency was maintained in 96% of patients; unilateral iliac vein stent thrombus was seen in one patient. One-year follow-up was available in eight patients, with CT imaging demonstrating maintained patency. Median filter implantation time was 12.3 months (mean, 41.9 months; range, 0.8-245.1 months; standard deviation, 63.3 months). Advanced IVCF retrieval techniques were required for 17 procedures. One major AE and minor AE occurred; no patients died in the study period. Conclusions: Single-session iliocaval recanalization with IVCF retrieval has high rates of technical and clinical success in patients with IVCF-related chronic iliocaval thrombosis.

AB - Objective: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. Methods: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed. Inclusion criteria included computed tomography (CT) imaging and clinical presentations consistent with chronic (>30 days) IVCF-related chronic thrombosis. A retrospective analysis of technical success, clinical success as measured with the Venous Clinical Severity Score, use of advanced filter retrieval techniques, and AEs was performed. Primary patency was evaluated with CT at 1 to 3 months and 1 year. Data analysis was performed using a paired t-test. Results: There were 25 patients (median age, 58.0 years; standard deviation, 15.6 years) with eight types of IVCF encountered; all were treated in a single session. Technical success was achieved in all patients. Mean improvement in the Venous Clinical Severity Score was 1.4 (95% confidence interval, 1.0-1.7; P <.01) in the venous edema subscore and 0.6 (95% confidence interval, 0.2-1.0; P <.01) in the pain subscore. At 1 to 3 months, iliocaval stent patency was maintained in 96% of patients; unilateral iliac vein stent thrombus was seen in one patient. One-year follow-up was available in eight patients, with CT imaging demonstrating maintained patency. Median filter implantation time was 12.3 months (mean, 41.9 months; range, 0.8-245.1 months; standard deviation, 63.3 months). Advanced IVCF retrieval techniques were required for 17 procedures. One major AE and minor AE occurred; no patients died in the study period. Conclusions: Single-session iliocaval recanalization with IVCF retrieval has high rates of technical and clinical success in patients with IVCF-related chronic iliocaval thrombosis.

KW - Chronic venous occlusion

KW - IVC filters

KW - Iliocaval thrombosis

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