JOURNAL ARTICLE

Stenting of chronically obstructed inferior vena cava filters

Peter Neglén, Mathew Oglesbee, Jake Olivier, Seshadri Raju
Journal of Vascular Surgery 2011, 54 (1): 153-61
21316900

OBJECTIVES: A protective inferior vena cava (IVC) filter may later be incorporated into a chronic postthrombotic ilio-caval obstruction (occlusive, requiring recanalization, or nonocclusive). This study aims to assess the safety and stent-related outcome following stenting across an obstructed filter.

METHODS: From 1997 to 2009, 708 limbs had stenting for postthrombotic ilio-caval outflow obstruction (occlusion in 121 limbs). In 25 patients, an IVC filter was obstructed (Group X). The site was crossed by a guidewire and balloon dilated. The filter was markedly displaced sidewise or remodeled. A stent was placed across the IVC filter and redilated. In 28 other patients, the cephalad stenting terminated below a patent IVC filter (Group B). The remaining 655 patients had no previous IVC filter placement (Group no IVC filter present [NF]). The patients were followed to assess patency. The types of reintervention were noted.

RESULTS: The stenting maneuver through a variety of previously inserted IVC filters was safely performed without an apparent tear of the IVC, no clinical bleeding or abdominal symptoms, or pulmonary embolism. Mortality was nil; morbidity minimal. The primary and secondary cumulative patency rates at 54 months for limbs with postthrombotic obstruction were with and without IVC filter (38% and 40%; P = .1701 and 79% and 86%; P = .1947, respectively), and for limbs with stenting across the filter (Group X) and stent termination below the filter (Group B; 32% and 42%; P = .3064 and 75% and 84%; P = .2788, respectively), not statistically different. When Group X alone was compared with Group NF, the secondary patency rate was, however, significantly lower (75% vs 86%; P = .0453), suggesting that crossing of the stent was associated with reduced patency. Occlusive postthrombotic disease requiring recanalization was more frequent in Group X than in Group B and Group NF (68%, 25%, and 15%, respectively; P = .004). A comparison was therefore performed only between limbs stented for recanalized occlusions with (n = 23) and without IVC filters (n = 92) showing no difference (cumulative primary and secondary patency rates 30% and 35%; P = .9678 and 71% and 73%; P = .9319, respectively). Multiple logistic regression analysis also supported a significant association between patency rate and occlusive disease (odds ratio, 6.9; 95% confidence interval, 3.4-13.9; P < .0001), but not between patency rate and presence of an IVC filter (P = .5552).

CONCLUSIONS: Stenting across an obstructed IVC filter is safe. It appears that patency is not influenced by the fact that an IVC filter is crossed by a stent, but is related to the severity of postthrombotic disease (occlusive or nonocclusive obstruction) and the associated recanalization procedure.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
21316900
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"