A design modification to minimize tilting of an inferior vena cava filter does not deliver a clinical benefit Chinmaya Shelgikar, MD, Jahan Mohebali,

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A design modification to minimize tilting of an inferior vena cava filter does not deliver a clinical benefit Chinmaya Shelgikar, MD, Jahan Mohebali, BS, Mark R. Sarfati, MD, Michelle T. Mueller, MD, Daniel V. Kinikini, MD, Larry W. Kraiss, MD Journal of Vascular Surgery Volume 52, Issue 4, Pages 920-924 (October 2010) DOI: 10.1016/j.jvs.2010.05.013 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Appearance of the standard (Günther-Tulip) vs modified (Celect) filter. Reprinted with permission from Buecker et al.13 Journal of Vascular Surgery 2010 52, 920-924DOI: (10.1016/j.jvs.2010.05.013) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Method of measuring tilt angle of IVC filters. The degree of tilt is defined as the angle between a line parallel to the side wall of the inferior vena cava (IVC) and a line through the central longitudinal axis of the filter. In this case, the angle was measured at 16°. Journal of Vascular Surgery 2010 52, 920-924DOI: (10.1016/j.jvs.2010.05.013) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Tilting characteristics of standard vs modified IVC filters. A, Box and whisker plots of insertion tilt angles for standard and modified filters. The line in the box represents the median, the dimensions of the box represent the 25th-75th interquartile range and the error bars represent the range of the data set for each filter type. Difference in tilt angle was analyzed by the Wilcoxon ranked sum test. There was no significant difference in overall insertion tilt angle between the standard and modified filters. B, Box and whisker plots of insertion tilt angles for standard and modified filters stratified by jugular or femoral approach. There were significant differences in insertion tilt angle between the filter types when analyzed by the femoral or jugular approach; modified filters tilted less than standard filters when placed from the jugular approach but tilted more when placed from the femoral approach. When each individual filter type was analyzed according to the approach used, standard filters showed no difference in tilting whether placed from the jugular or femoral approach (P = .83), whereas modified filters had significantly greater tilt angles when placed from the femoral as opposed to the jugular approach (P < .0001). All statistical analyses performed using the Wilcoxon ranked sum test. C, Modified filters demonstrated a small but significant trend toward self-centering, achieving a greater positive change in tilt angle than standard filters between insertion and removal (P = .03, Wilcoxon ranked sum test). Journal of Vascular Surgery 2010 52, 920-924DOI: (10.1016/j.jvs.2010.05.013) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Correlation of inferior vena cava (IVC) filter tilt angles with IVC diameter. A, There is no significant correlation between insertion tilt angles and IVC diameter. B, There is no observable correlation between IVC diameter and change in tilt angle from insertion to removal. Journal of Vascular Surgery 2010 52, 920-924DOI: (10.1016/j.jvs.2010.05.013) Copyright © 2010 Society for Vascular Surgery Terms and Conditions