2. CRT 2012 Primer for Endovascular Interventions

3. IVC Filters: When? Which Ones? And How?

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

5. 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

6. 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

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

8. Ideal Caval Filter Easily deployed Percutaneous approach
Small puncture site
Biocompatible

9. Nonthrombogenic Ideal Caval Filter Stress resistant
Percutaneously removed

10. Greenfield
Meditech-Boston Scientific

11. When ?

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

13. 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.

14. Which Filter ?

15. Vena Cava Filters

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

17. How ?

20. Cook Inc.

25. Removal of optional filters using currently available percutaneous techniques

26. What do you need?

27. Favorable anatomy

29. IVC Filter Removal Straight forward and Complex

30. Equipment Sheaths Directional catheters Directional guidewires
Loop snares
Grasping devices
Baskets

31. ev3

32. Amplatz GOOSE NECK® Snare Kit (ev3)
Nitinol cable with gold plated tungsten loop & platinum-iridium marker band.
90 degree snare loop.
Wide range of loop diameters:
5 mm – 35 mm.
Catheter length = 102 cm.
Snare length = 120 cm.

33. EN Snare® (Angiotech / Hatch Medical)
Three nitinol loops with interwoven platinum strands for radiopacity and radiopaque band.
Angled catheter tip (15°)
Wide range of loop diameters:
6 mm. – 45 mm.
Catheter length = 100 cm.
Snare length = 120 cm.

34. EXPRO Elite™ Snare (Radius Med. Tech.)
Helical shaped loop made from cobalt chromium makes loop
and tip radiopaque.
Wide range of loop diameters:
5 mm – 35 mm.
Snare & catheter length = 150 cm. (integrated system).
Distributed by both Vascular Solutions and by Abbott.

35. Removal of an “Intravascular Foreign Body”
Straight forward
Loop snare
Grasping device
Complex
Multiple devices used including angioplasty balloons, bronchoscopy forceps, and the“in situ” snare technique.

36. Retrieval with a snare and a long sheath or guiding catheter
Günther Tulip (Cook)
Celect (Cook)
Opt Ease (Cordis Endovascular)
Option (Angiotech)
G 2 X, Eclipse, Meridian (Bard)

37. Retrieval with a “grasping”device
Recovery Filter, G 2 (Bard Peripheral Vascular)
Aln (Aln Implants)

38. Snare Retrieval
EnSnare

39. G 2 Filter Cone
Bard Peripheral Vascular.

40. Bard Peripheral Vascular.

41. Recovery (G 2) Retrieval

42. Can a Permanent IVC Filter be Removed?

53. Take Home Points