Anticoagulants are the treatment of choice for pulmonary embolism. When these fail or are contraindicated, vena cava filters are effective devices for preventing clots from the legs from migrating to the lung. Many uncertainties exist when a filter is inserted, especially during physiological activity such as normal breathing and the Valsalva maneuver. These activities are often connected with filter migration and vena cava damage due to the various related vein geometrical configurations. In this work, we analyzed the response of the vena cava during normal breathing and Valsalva maneuver, for a healthy vena cava and after insertion of a commercial Günther-Tulip® filter. Validated computational fluid dynamics (CFD) and patient specific data are used for analyzing blood flow inside the vena cava during these maneuvers. While during normal breathing, the vena cava flow can be considered almost stationary with a very low pressure gradient, during Valsalva the extravascular pressure compresses the vena cava resulting in a drastic reduction of the vein section, a global flow decrease through the cava but increasing the velocity magnitude. This change in the section is altered by the presence of the filter which forces the section of the vena cava before the renal veins to keep open. The effect of the presence of the filter is investigated during these maneuvers showing changes in wall shear stress and velocity patterns.

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In this study, the trapping ability of the Günther Tulip and Celect inferior vena cava filters was evaluated. Thrombus capture rates of the filters were tested in vitro in horizontal position with thrombus diameters of 3 and 6mm and tube diameter of 19mm. The filters were tested in centered and tilted positions. Sets of 30 clots were injected into the model and the same process was repeated 20 times for each different condition simulated. Pressure drop experienced along the system was also measured and the percentage of clots captured was recorded. The Günther Tulip filter showed superiority in all cases, trapping almost 100% of 6mm clots both in an eccentric and tilted position and trapping 81.7% of the 3mm clots in a centered position and 69.3% in a maximum tilted position. The efficiency of all filters tested decreased as the size of the embolus decreased and as the filter was tilted. The injection of 6 clots raised the pressure drop to 4.1mmHg, which is a reasonable value that does not cause the obstruction of blood flow through the system.