Magnification Spot Radiographs Improve Assessment for Inferior Vena Cava Filter Fractures prior to Removal Compared to CT.

PURPOSE To determine if magnification spot radiographs acquired before attempting inferior vena cava (IVC) filter removal have value in the assessment for filter fractures. MATERIALS AND METHODS A retrospective review of complex IVC filter removals performed at a tertiary referral center from October 2015 to May 2017 was performed. Magnification spot radiographs (frontal and at least 2 oblique views) were obtained with the fluoroscopic unit in the procedure suite prior to venous access for filter removal. Patients were included in the study if a computed tomography (CT) scan of the abdomen/pelvis before filter removal was available. Ninety-six patients (47 women and 49 men) were included. Most removed filters were the Recovery/G2/G2X/Eclipse/Meridian (n = 28), the Günther Tulip (n = 26), and the Celect/Celect Platinum (n = 22). Blinded review of the pre-procedural CT scans and spot radiographs for the presence of filter fractures was performed by 2 interventional radiologists. Accuracy of each modality was assessed using the status of the explanted filter as the gold standard. Agreement between the 2 readers was assessed with the kappa statistic. RESULTS Fractures were present in 27 explanted filters (28%). Accuracy of CT was 88% and 68% for readers 1 and 2, respectively, which increased to 98% and 97% with magnification spot radiographs. The kappa statistic was 0.12 for CT and 0.97 for spot radiographs. CONCLUSIONS Magnification spot radiographs acquired before attempting IVC filter removal improve detection of filter fractures and agreement among interventional radiologists. Therefore, these should be performed routinely to allow for optimal treatment planning.

[1]  Nam S Hoang,et al.  Endovascular Removal of Fractured Inferior Vena Cava Filter Fragments: 5-Year Registry Data with Prospective Outcomes on Retained Fragments. , 2018, Journal of vascular and interventional radiology : JVIR.

[2]  J. Bullen,et al.  Prevalence and clinical consequences of fracture and fragment migration of the Bard G2 filter: imaging and clinical follow-up in 684 implantations. , 2014, Journal of vascular and interventional radiology : JVIR.

[3]  S. Stavropoulos,et al.  Endovascular Removal of Inferior Vena Cava Filters with Arterial Penetration. , 2018, Journal of vascular and interventional radiology : JVIR.

[4]  J. Bullen,et al.  Penetration of Celect inferior vena cava filters: retrospective review of CT scans in 265 patients. , 2014, AJR. American journal of roentgenology.

[5]  S. W. Robertson,et al.  Bard Recovery filter: evaluation and management of vena cava limb perforation, fracture, and migration. , 2009, Journal of vascular and interventional radiology : JVIR.

[6]  S. Stavropoulos,et al.  Management of Fractured Inferior Vena Cava Filters: Outcomes by Fragment Location. , 2017, Radiology.

[7]  S. Stavropoulos,et al.  Retrieval of Tip-embedded Inferior Vena Cava Filters by Using the Endobronchial Forceps Technique: Experience at a Single Institution. , 2015, Radiology.

[8]  Stephen L. Wang,et al.  Long-term complications of inferior vena cava filters. , 2017, Journal of vascular surgery. Venous and lymphatic disorders.

[9]  A. Rosenkrantz,et al.  National Trends in Inferior Vena Cava Filter Placement and Retrieval Procedures in the Medicare Population Over Two Decades. , 2018, Journal of the American College of Radiology : JACR.

[10]  J. Kaufman,et al.  Systematic review of the use of retrievable inferior vena cava filters. , 2011, Journal of vascular and interventional radiology : JVIR.

[11]  Kush R Desai,et al.  Retrievable IVC Filters: Comprehensive Review of Device-related Complications and Advanced Retrieval Techniques. , 2017, Radiographics : a review publication of the Radiological Society of North America, Inc.

[12]  S. Stavropoulos,et al.  Removal of fractured inferior vena cava filters: feasibility and outcomes. , 2012, Journal of vascular and interventional radiology : JVIR.

[13]  M. Geisinger,et al.  Fracture and distant migration of the Bard Recovery filter: a retrospective review of 363 implantations for potentially life-threatening complications. , 2012, Journal of vascular and interventional radiology : JVIR.

[14]  Michael J. Lee,et al.  The CIRSE Retrievable IVC Filter Registry: Retrieval Success Rates in Practice , 2015, CardioVascular and Interventional Radiology.

[15]  M. Crowther,et al.  Indications, complications, and management of inferior vena cava filters: the experience in 952 patients at an academic hospital with a level I trauma center. , 2013, JAMA internal medicine.

[16]  S. Stavropoulos,et al.  Embedded inferior vena cava filter removal: use of endobronchial forceps. , 2008, Journal of vascular and interventional radiology : JVIR.

[17]  W. Nicholson,et al.  Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. , 2010, Archives of internal medicine.

[18]  S. Stavropoulos,et al.  Reporting of Inferior Vena Cava Filter Complications on CT: Impact of Standardized Macros. , 2018, AJR. American journal of roentgenology.

[19]  T. Walker,et al.  Inferior vena cava filter retrievals, standard and novel techniques. , 2016, Cardiovascular diagnosis and therapy.

[20]  Endobronchial Forceps-Assisted and Excimer Laser-Assisted Inferior Vena Cava Filter Removal: The Data, Where We Are, and How It Is Done. , 2018, Techniques in vascular and interventional radiology.

[21]  V. Krishnasamy,et al.  Complications of Celect, Günther tulip, and Greenfield inferior vena cava filters on CT follow-up: a single-institution experience. , 2013, Journal of vascular and interventional radiology : JVIR.

[22]  J. Kaufman,et al.  Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. , 2006 .