Excimer Laser–assisted Retrieval of Günther Tulip Vena Cava Filters: A Pilot Study in a Canine Model

Saito, Naritatsu; Shimamoto, Takeshi; Takeda, Takahide; Marui, Akira; Kimura, Takeshi; Ikeda, Tadashi; Sakata, Ryuzo

doi:10.1016/j.jvir.2010.01.028

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Experimental use of a laser-assisted sheath technique for removal of embedded filters was described in an animal model 19 and recently reported in human studies. 9,20 Based on early results, the current study was conducted to further investigate this technique and protocol in a larger patient cohort containing a variety of embedded filter types.…”

Section: Discussionmentioning

confidence: 99%

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Kuo

Odegaard

Rosenberg

et al. 2013

Circ: Cardiovascular Interventions

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Background-Although chronically implanted inferior vena cava filters may result in filter-related morbidity, there is currently no routine option for removing such filters when they become firmly embedded along the vena cava endothelium. Methods and Results-During a 3-year period, 100 consecutive patients were prospectively enrolled in a single-center study. There were 42 men and 58 women (mean age, 46 years; limits, 18-76 years). Retrieval indications included filterrelated acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration. Filter retrieval was also performed to prevent risks from prolonged implantation and to potentially eliminate the need for lifelong anticoagulation. After standard methods failed, photothermal tissue ablation was attempted with a laser sheath powered by a 308-nm xenon chloride excimer laser. Applied forces were recorded with a digital tension meter before and during laser activation. Laser-assisted retrieval was successful in 98.0% (95% confidence interval [CI], 93.0%-99.8%) with mean implantation of 855 days (limits, 37-6663 days; >18 years). The following filter types were encountered in this study: Günther-Tulip (n=34), Celect (n=12), Option (n=17), Optease (n=20, 1 failure), TrapEase (n=6, 1 failure), Simon-Nitinol (n=1), 12F Stainless Steel Greenfield (n=4), and Titanium Greenfield (n=6). The average force during failed standard retrievals was 7.2 versus 4.6 pounds during laser-assisted retrievals (P<0.0001). The major complication rate was 3.0% (95% CI, 0.6%-8.5%), the minor complication rate was 7.0% (95% CI, 0.3%-13.9%), and there were 4 adverse events (2 coagulopathic hemorrhages, 1 renal infarction, and 1 cholecystitis; 4.0%; 95% CI, 1.1%-9.9%) at mean follow-up of 500 days (limits, 84-1079 days). Scar tissue ablation was histologically confirmed in 96.0% (95% CI, 89.9%-98.9%). Successful retrieval allowed cessation of anticoagulation in 30 of 30 (100%) patients and alleviated morbidity in 23 of 24 patients (96%). Conclusions-Excimer laser-assisted removal is effective in removing embedded inferior vena cava filters refractory to standard retrieval and high force. This method can be safely used to prevent and alleviate filter-related morbidity. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01158482.

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Section: Discussionmentioning

confidence: 99%

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Kuo

Odegaard

Rosenberg

et al. 2013

Circ: Cardiovascular Interventions

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“…We also determined and confirmed histologically that these adherent tissues could be separated between the filter struts and vessel walls with less force by using an excimer laser sheath system designed for controlled tissue ablation. Similarly, Saito et al [10] showed that laser-assisted retrieval of a GTF incorporated into the IVC wall was feasible in dogs; and initial successful use in a human patient was recently published [6]. Additionally, extensive research has been reported on laser-tissue interaction with this laser system [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

Kuo

Cupp

Louie

et al. 2011

Cardiovasc Intervent Radiol

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“…Kuo et al first reported the successful use of this technique in a canine model [22] and subsequently showed its effectiveness in human subjects [20,35]. In this technique, an intravascular laser is used to ablate fibrotic tissue and to dissect the embedded filter hook or components from the caval wall.…”

Section: Laser Thermal Dissection Techniquementioning

confidence: 99%

Novel and Advanced Techniques for Complex IVC Filter Retrieval

Daye

Walker

2017

Curr Treat Options Cardio Med

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Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.

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Excimer Laser–assisted Retrieval of Günther Tulip Vena Cava Filters: A Pilot Study in a Canine Model

Cited by 9 publications

References 25 publications

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

Novel and Advanced Techniques for Complex IVC Filter Retrieval

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