Document Detail


Follow-up after insertion of Bird's Nest inferior vena caval filters.
MedLine Citation:
PMID:  8640416     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the long-term clinical and radiographic outcome of patients who undergo insertion of a Gianturco-Roehm Bird's Nest vena caval filter (Cook Inc., Bloomington, Ind.). PATIENTS AND METHOD: The medical records of 40 patients who, over a 34-month period, underwent insertion of a Bird's Nest filter were reviewed and the reasons for filter insertion determined. The causes of any subsequent deaths were noted, and the autopsy findings, when available, were reviewed. Surviving patients were contacted, and 12 were willing to return for follow-up imaging, which consisted of plain radiography, real-time ultrasonography, colour Doppler imaging and contrast-enhanced computed tomography. Changes in filter position, the presence of thrombus and perforation of the vessel wall by the filter struts were documented. RESULTS: All 10 patients who underwent filter insertion while in an intensive care unit (ICU) died, an average of 22 days after the procedure. Eleven other patients also died. Recurrent pulmonary embolism was not suspected in any of these patients, and five autopsies revealed no caval thrombosis. Imaging studies in 12 of the surviving patients revealed no occlusion of the inferior vena cava and no filter migration; however, the vena caval wall was perforated in all of these patients. Nonocclusive intrafilter thrombus was detected by colour Doppler imaging in three patients. CONCLUSIONS: In this small group of patients the Bird's Nest filter was effective in preventing recurrent pulmonary embolism and caused less caval thrombosis than has previously been suspected, although intrafilter clot was found in 25% of the patients who underwent follow-up imaging. Colour Doppler imaging is the method of choice for detecting nonocclusive thrombus with this type of filter. Perforation of the caval wall was universal but not clinically symptomatic. Finally, guidelines should be established to ensure the cost-effective use of inferior vena caval filters in ICU patients.
Authors:
M S Starok; A A Common
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes     Volume:  47     ISSN:  0846-5371     ISO Abbreviation:  Can Assoc Radiol J     Publication Date:  1996 Jun 
Date Detail:
Created Date:  1996-07-15     Completed Date:  1996-07-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8812910     Medline TA:  Can Assoc Radiol J     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  189-94     Citation Subset:  IM    
Affiliation:
Department of Medical Imaging, University of Toronto, Ontario.
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MeSH Terms
Descriptor/Qualifier:
Cause of Death
Contrast Media
Cost-Benefit Analysis
Equipment Design
Equipment Failure
Follow-Up Studies
Foreign-Body Migration / etiology
Humans
Intensive Care
Iohexol / diagnostic use
Pulmonary Embolism / etiology
Radiographic Image Enhancement
Retrospective Studies
Survival Rate
Thrombosis / radiography,  ultrasonography
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Color
Vascular Patency
Vena Cava Filters* / adverse effects,  economics
Vena Cava, Inferior / injuries,  radiography,  ultrasonography
Chemical
Reg. No./Substance:
0/Contrast Media; 66108-95-0/Iohexol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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