Roger A. Orsini, M.D., Bruce E. Jarrell, M.D.

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Presentation transcript:

Suprarenal placement of vena caval filters: Indications, techniques, and results Roger A. Orsini, M.D., Bruce E. Jarrell, M.D. Journal of Vascular Surgery Volume 1, Issue 1, Pages 124-135 (January 1984) DOI: 10.1016/0741-5214(84)90192-7 Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 1 Renal function studies on patients with suprarenal filters. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 2 Patient No. 1 had proteinuria and multiple PE on anticoagulants. A, Inferior venacavogram from below showed a large clot originating from iliac system. This film failed to demonstrate upper IVC, but a subsequent study (B) from a jugular vein catheter revealed a mound of thrombus in IVC at level of renal veins and a cutoff of dye into right renal vein. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 3 Patient No. 3 had multiple acute and chronic PE on heparin and warfarin sodium following a Spencer IVC plication. Lower extremity venogram showed DVT, but IVD was not visible. A study performed from upper extremity revealed occlusion of IVC at plication with large collateral veins. In addition, there was a large thrombus in suprarenal IVC extending to inferior margin of T-11. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 4 A, Patient No. 4 had multiple recurrent PE despite use of both heparin and an infrarenal filter. Inferior venacavogram demonstrated thrombus originating from filter and extending into suprarenal IVC at top of T-12 (arrow). Streptokinase failed to prevent recurrent PE or lyse clot on filter as demonstrated by repeat studies. B, Insertion of a suprarenal filter terminated further emboli. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 5 Patient No. 6 had chronic PE on warfarm sodium and heparin. A pulmonary angiogram revealed multiple new and old emboli with a pulmonary artery pressure of 65/25 mm Hg. Cardiac catheterization and bilateral leg venograms were negative. A and B, Inferior venacavogram was negative. C, Right renal venogram was negative. D and E, A selective left renal venogram demonstrated a thrombus in large left ovarian vein. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 6 Patient No. 7 had a large perirenal IVC thrombus that was initially treated with heparin. Major hemorrhagic complications that required discontinuance of heparin and insertion of a suprarenal filter developed. Upper arm arrow points to top of clot, and lower two arrows locate both renal veins. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 7 A, Patient No. 9 had a large carcinoma involving right kidney with an IVC thrombus extending to level of T-11. B, X-ray film shows relationship between top of clot and right atrium at top of picture. C, Filter after having been positioned over thrombus. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 8 Patient No. 11 had fever of unknown source following an acute spinal cord injury resulting in quadriplegia. Lower extremity venogram failed to demonstrate IVC. On performance of that study, a large floating thrombosis originating in right iliac vein was seen extending to level of base of T-12. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 9 Ultrasound study following insertion of suprarenal filter demonstrating regional anatomy of IVC above filter. Real-time Doppler ultrasound revealed normal blood flow in IVC around filter. RA = right atrium; NC = normal cava above filter; GF = Greenfield filter. Journal of Vascular Surgery 1984 1, 124-135DOI: (10.1016/0741-5214(84)90192-7) Copyright © 1984 Mosby, Inc. Terms and Conditions