1. CRT Venous Disease

2. IVC Filters: Are Class Differences Meaningful?

3. Anthony C. Venbrux, MD Professor of Radiology and Surgery
Director, Vascular and Interventional Radiology
The George Washington University
Medical Center
Washington, DC

4. Anthony Venbrux, MD Cook, Inc. Cordis Endovascular
Honoraria received for medical lectures:
Cook, Inc.
Cordis Endovascular
Bard Peripheral Vascular
Terumo Interventional Systems
Medrad-Possis Interventional
Rex Medical
Consultant - Bard Peripheral Vascular
Consultant - ArtVentive Medical

5. Special Thanks To: Shawn N. Sarin, MD Andrew S. Akman, MD
Albert K. Chun, MD
Amy P. Harper, ACNP-BC
Noel Clay Haskins, MD
Frank Lynch, MD
John Kaufman, MD
Shundra D. Dinkins

6. Objectives 2) Techniques of deployment 3) Clinical applications
1) Background
2) Techniques of deployment
3) Clinical applications
4) Complications

7. Classic Filter Indications
Thrombo-embolic disease (TED) with
Contraindication for anticoagulation.
Complication of anticoagulation.
Failure of anticoagulation.
Massive pulmonary embolism.
Chronic, recurrent pulmonary embolism.

8. Extended Indications – Off Label
DVT/PE with poor compliance.
“Widow maker” thrombus.
Poor respiratory/pulmonary reserve.
Unsteady patient (fall risk).
No DVT/PE but at high risk for development .

9. Use of IVC Filters Marked increase in the last 20 years. Estimates:
2,000 implanted in 1979.
49,000 implanted in 1999.
Stein PD et al, Arch Intern Med 2004;164:

10. Growth of IVC Filter Use
Retrievable IVC Filter technology has made it justifiable to place an IVC filter in patient populations under the premise that the device will be removed1.
1979 – 2,000 IVC filters placed
2007 – 167,000 IVC filters placed
2012 – est. 259,000 IVC filters to be placed
Retrieval rates have historically been about 20%2
Large number of devices needlessly left in place in patients for years / decades.
U.S. Food and Drug Administration Alerts and Notices (Medical Devices). Removing Retrievable Inferior Vena Cava Filters: Initial Communication (Accessed ).
Karmy-Jones R, Jurkovich GJ, Velmahos GC, et al. Practice patterns and outcomes of retrievable vena cava filters in trauma patients: An AAST multicenter study. J Trauma 2007; 62:17-24.

11. Long Term Complications of IVC Filters (as seen with permanent devices)
Recurrent DVT ~20%1
IVC Thrombosis %2
Filter Migration %2
Filter Fracture / Embolization 1-6+%2,3
IVC Penetration %2
As previously mentioned, there are associated complications of IVC filter placement
Thrombotic complications are by far the most common. An increased risk of recurrent DVT, presumably due to a reduction of blood flow in the IVC, has also been documented with an overall rate of about 20%. Most partial IVC thromboses, documented by CT or US are asymptomatic and may actually be evidence of successful filter function. Complete IVC thrombosis is rare but may lead to phlegmasia.
Movement of the filter from its original deployed position has also been reported in multiple series. Frank embolization of all or part of the filter to the heart or pulmonary artery has been reported in 2-5% of cases and is usually associated with guide wire entanglement during a central line placement procedure.
Penetration of the filter legs trough the caval wall becomes more likely the longer a filter remains in place. Fortunately, filter leg penetration is associated with injury to adjacent structures less than 1% of the time.
Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998; 338:
Kinney TB. Update on inferior vena cava filters. J vasc Interv Radiol 2003; 14:
Vijay K, Hughes JA, Lynch FC, et al. Fractured Bard Recovery, G2 and G2 Express Inferior Vena Cava Filters: Incidence, clinical consequences and outcomes of removal attempts. J Vasc Interv Radiol Epub ahead of print.

12. Vena Cava Filters Definitions Permanent Cannot be removed. Temporary
Implies the filter must be removed.
Optional
Either permanent or retrievable.

13. History: A Perspective

16. Greenfield
Meditech-Boston Scientific

17. Permanent Caval Filters In the USA
Kimray-Greenfield stainless
Titanium Greenfield
Over-the-wire stainless steel Greenfield
Gianturco-Rhoem Bird’s Nest

18. Greenfield
Meditech-Boston Scientific

23. Meditech-Boston Scientific

24. Meditech-Boston Scientific

25. Cook Inc.

26. Cook Inc.

27. Permanent Caval Filters In the USA
Simon Nitinol
Vena Tech
Low Profile (LP) Vena Tech

28. Bard Peripheral Vascular

31. B Braun Medical Inc.

32. Permanent Caval Filters In the USA
TrapEase
OptEase
Gunther Tulip, Celect
Recovery, G 2, Eclipse, Meridian
Option
Aln

33. Gunther Tulip
Cook Inc.

34. Cook Celect

35. ev3

36. Cordis Endovascular

37. Opt Ease
Cordis Endovascular

38. Recovery Filter (Discontinued 9/2005)
Bard Peripheral Vascular

39. Recovery Filter Cone
Bard Peripheral Vascular.

40. Bard Peripheral Vascular.

41. G2™ Filter System
Bard Peripheral Vascular.

42. G 2 X, and Eclipse
Bard Peripheral Vascular.

43. Meridian™ Vena Cava Filter
Bard Peripheral Vascular

44. Option IVC Filter
Rex Medical

45. Aln
Aln Implants

46. Non-Permanent Filters: An Old Idea
1968:

47. Gross Pathology
6 weeks in situ

48. Histopathology Transmural Incorporation

49. 12 weeks post-removal 8 weeks healing

50. 8 Week Healing
IVC Diameters mm

51. Optional Filters

52. Current U.S. Optional Filter Designs
Meridian™
OptEase™
Tulip™
ALN
Celect™
Option™

53. Vena Cava Filters

54. 54

56. Take Home Points