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Stenting of chronically obstructed inferior vena cava filters

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Presentation on theme: "Stenting of chronically obstructed inferior vena cava filters"— Presentation transcript:

1 Stenting of chronically obstructed inferior vena cava filters
Peter Neglén, MD, PhD, Mathew Oglesbee, BS, Jake Olivier, PhD, Seshadri Raju, MD  Journal of Vascular Surgery  Volume 54, Issue 1, Pages (July 2011) DOI: /j.jvs Copyright © 2011 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Left, Venogram showing a thrombosis of a previously placed inferior vena cava (IVC) filter and stented ilio-femoral veins below. Collateral circulation through the ascending lumbar veins filling the normal IVC above the occluded filter is visualized. Right, The IVC filter is incorporated in a balloon dilation of the ilio-caval segment, remodeled and then stented across. Venogram shows unobstructed venous outflow. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Left, Venogram showing left postthrombotic iliofemoral vein obstruction with previously placed inferior vena cava (IVC) filter (inset). Middle, The obstruction and filter are traversed by a guidewire and intravascular ultrasound (IVUS) has shown no stenosis or thrombus. Right, The caudad obstruction has been dilated and stented. The cephalad termination of the stent is below the untouched IVC filter. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Left, The occluded inferior vena cava (IVC) filter is recanalized using the same technique as for the caudad venous occlusion by using a soft or semi-stiff Glidewire. Once the correct plane has been entered, rapid progress can usually be achieved without perforation by developing a loop or supporting a soft wire with a catheter during manipulation. Middle, The guidewire has been pushed across the occluded stent. Right, A small guiding catheter has been placed with its tip above the obstruction, and the correct position is checked by an injection of dye. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Left, Predilation is performed using a smaller balloon. Middle, The channel that is created allows passage of a wider (16-18 mm) high-pressure balloon (inflated to atm), which is used to markedly remodel the inferior vena cava (IVC) filter. Right, A stent can now be placed across the IVC filter and is then redilated with the high-pressure balloon. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Five examples of stented inferior vena cava (IVC) filters with and without prongs, which have been remodeled, crushed and displaced sidewise, and/or fractured. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Cumulative primary and secondary patency rates of patients stented for postthrombotic obstruction with (n = 44) and without (n = 555) previously inserted inferior vena cava (IVC) filter. The lower numbers represent limbs at risk at each time interval (all standard error of means <10%). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Cumulative primary and secondary patency rates after stenting of postthrombotic obstruction in Group B (stenting terminating below the inferior vena cava [IVC] filter) and Group X (stenting across the IVC filter). The lower numbers represent stented patients at risk at each time interval (standard error of means >10% are shown by placing error bars). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Cumulative primary and secondary patency rates after stenting of postthrombotic occlusion requiring recanalization, with (n = 23) and without (n = 92) previously inserted inferior vena cava (IVC) filter. The lower numbers represent stented patients at risk at each time interval (standard error of means >10% are shown by placing error bars). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

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