tips and tricks for challenging & complex ivc filter …
TRANSCRIPT
![Page 1: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/1.jpg)
Fakhir Elmasri, MDLakeland Vascular Institute
Lakeland, Florida
TIPS AND TRICKS FOR CHALLENGING & COMPLEX
IVC FILTER REMOVAL
![Page 2: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/2.jpg)
2
Fakhir Elmasri, M.D.LVI President and Founder
![Page 3: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/3.jpg)
3
Providing a comprehensive
approach to patient care.
![Page 4: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/4.jpg)
4
![Page 5: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/5.jpg)
5
![Page 6: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/6.jpg)
6
![Page 7: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/7.jpg)
IVC Filter Complications• Thrombosis/PE
• Caval Thrombosis: 3.7%
• DVT: Increase 50%
• PE: 5.6% Non-Fatal, 3.7% Fatal
• Malposition & Migration
• Defective Deployment
• Bleeding
• Infection
• Leg Perforation/ Fracture
• Incident rate 40%, unclear on
how time of implantation affects thrombosis rate.
7Ha, T. G. (2006). Complications of Inferior Vena Caval Filters. Retrieved June 29, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036364/
![Page 8: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/8.jpg)
8
MISPLACEMENTS
![Page 9: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/9.jpg)
9
MISPLACEMENTS
![Page 10: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/10.jpg)
Tilted Filters
Case # 1
![Page 11: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/11.jpg)
11
Start with a 16F x 45cm sheath with a 9F x 55cm sheath through it.
![Page 12: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/12.jpg)
12
Loop the neck of the filter with a wire and snare it back through the 9F sheath
![Page 13: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/13.jpg)
13
Advance the 9F sheath and cinch it tight around the neck of the filter
![Page 14: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/14.jpg)
14
Advance the 16F sheath down against the neck of the filter
![Page 15: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/15.jpg)
15
Pull the 9F cinched sheath and BARD G2 & Eclipse filters will fold in half at the neck into the 16F sheath. Successful retrieval with a normal post cavagram.
![Page 16: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/16.jpg)
CASE #2
![Page 17: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/17.jpg)
17
Switch to 16F loop snare technique
![Page 18: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/18.jpg)
18
Freed the hook from wall for another snare attempt
![Page 19: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/19.jpg)
19
Snared the hook and retrieved the filter successfully
![Page 20: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/20.jpg)
20
Retrieval of tilted filter in a 39 year old
![Page 21: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/21.jpg)
21
Unable to snare the hook as it is embedded in the wall
![Page 22: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/22.jpg)
22
Convert to 16F loop snare technique
![Page 23: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/23.jpg)
23
Fold the Eclipse filter in half and retrieve through the 16F sheath
![Page 24: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/24.jpg)
Case # 3
24
PE in a patient with a Tilted Guenther Tulip Filter
![Page 25: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/25.jpg)
Retrieval of an embedded Guenther Tulip filter in place for over 2 years
➢63 yr old patient w/Gunther Tulip presented with PE
➢Patient recently presented w/recurrent lower extremity DVT along with new episodes of pulmonary embolism➢No DVT was observed in the upper extremeties
➢Upon review of CT, tilt was observed and was cause for concern due to patient symptoms
25
![Page 26: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/26.jpg)
Hook of the filter embedded in the Vena Cava Wall
26
![Page 27: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/27.jpg)
Gooseneck + Forcep Retrieval Technique
27
![Page 28: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/28.jpg)
Gooseneck + Alligator Forceps Technique
28
![Page 29: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/29.jpg)
29
![Page 30: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/30.jpg)
30
![Page 31: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/31.jpg)
31
Gooseneck snare Alligator Forceps
![Page 32: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/32.jpg)
32
![Page 33: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/33.jpg)
33
![Page 34: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/34.jpg)
34
![Page 35: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/35.jpg)
35
![Page 36: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/36.jpg)
Filter is removed
36
![Page 37: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/37.jpg)
37
![Page 38: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/38.jpg)
Final Cavagram
38
![Page 39: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/39.jpg)
Denali Placed Post-Tulip Removal
39
![Page 40: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/40.jpg)
Case # 1
Filter Penetration
40
![Page 41: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/41.jpg)
• Upper GI bleed and endoscopy was performed. Bleeding was found in the duodenum where a limb of the filter had perforated.
• Was contacted by surgeon who was having difficulty retrieving the filter due to apex of the filter being embedded in the cava wall.
• After attempting to talk surgeon through various retrieval techniques with patient on the table the decision was made to refer patient to us.
41
![Page 42: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/42.jpg)
Multiple techniques used to remove difficult embedded filter
42
![Page 43: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/43.jpg)
Case # 2Back Pain Started Immediately Post IVC Filter
Filter Penetration
43
![Page 44: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/44.jpg)
44
![Page 45: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/45.jpg)
45
![Page 46: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/46.jpg)
46
![Page 47: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/47.jpg)
47
F/U after 4 months back pain didn't subside, CT Scan performed…
![Page 48: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/48.jpg)
48
![Page 49: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/49.jpg)
49
![Page 50: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/50.jpg)
50
![Page 51: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/51.jpg)
51
![Page 52: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/52.jpg)
52
![Page 53: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/53.jpg)
53
![Page 54: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/54.jpg)
54
![Page 55: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/55.jpg)
55
![Page 56: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/56.jpg)
56
![Page 57: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/57.jpg)
57
![Page 58: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/58.jpg)
58
![Page 59: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/59.jpg)
59
![Page 60: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/60.jpg)
60
Penetrated leg from Simon Nitinol filter causing pain
![Page 61: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/61.jpg)
61
![Page 62: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/62.jpg)
62
![Page 63: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/63.jpg)
63
![Page 64: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/64.jpg)
Mal Deployment
Case # 1
64
![Page 65: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/65.jpg)
![Page 66: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/66.jpg)
![Page 67: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/67.jpg)
CT Coronal Reformats
67
![Page 68: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/68.jpg)
![Page 69: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/69.jpg)
![Page 70: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/70.jpg)
![Page 71: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/71.jpg)
![Page 72: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/72.jpg)
![Page 73: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/73.jpg)
![Page 74: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/74.jpg)
![Page 75: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/75.jpg)
![Page 76: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/76.jpg)
![Page 77: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/77.jpg)
![Page 78: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/78.jpg)
![Page 79: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/79.jpg)
![Page 80: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/80.jpg)
![Page 81: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/81.jpg)
![Page 82: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/82.jpg)
CASE #2
Mal Deployment
![Page 83: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/83.jpg)
83
![Page 84: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/84.jpg)
84
![Page 85: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/85.jpg)
85
![Page 86: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/86.jpg)
86
![Page 87: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/87.jpg)
Mal Deployment
Case # 3
![Page 88: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/88.jpg)
Case Number 1
88
67 year old male comes in for AV shunt access
![Page 89: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/89.jpg)
89
What is that ?
![Page 90: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/90.jpg)
90
What is that doing there?
![Page 91: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/91.jpg)
91
Lets go get it!
![Page 92: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/92.jpg)
92
Lets go get it!
![Page 93: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/93.jpg)
93
Maybe not
![Page 94: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/94.jpg)
94
Pre- angioplasty
![Page 95: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/95.jpg)
95
![Page 96: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/96.jpg)
96
![Page 97: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/97.jpg)
97
![Page 98: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/98.jpg)
98
![Page 99: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/99.jpg)
Filter Migration
99
Case # 1
![Page 100: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/100.jpg)
100
63 year old male presents with bilateral PE’s
Taken to cath lab for treatment
![Page 101: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/101.jpg)
101
What is going on here?
![Page 102: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/102.jpg)
102
![Page 103: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/103.jpg)
103
![Page 104: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/104.jpg)
104
![Page 105: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/105.jpg)
105
![Page 106: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/106.jpg)
106
![Page 107: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/107.jpg)
107
![Page 108: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/108.jpg)
108
CT 1 month earlier
![Page 109: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/109.jpg)
CASE # 1
Chronic IVC Occlusion
![Page 110: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/110.jpg)
•60 y/o male S/P Trapease filter placement more than 10 years ago, and has been
suffering from lower extremity edema/pain and large veins in the legs and abdomen for
6 years
![Page 111: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/111.jpg)
111
![Page 112: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/112.jpg)
112
![Page 113: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/113.jpg)
113
![Page 114: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/114.jpg)
114
![Page 115: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/115.jpg)
115
![Page 116: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/116.jpg)
116
![Page 117: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/117.jpg)
117
![Page 118: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/118.jpg)
118
![Page 119: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/119.jpg)
119
![Page 120: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/120.jpg)
120
![Page 121: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/121.jpg)
121
![Page 122: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/122.jpg)
122
![Page 123: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/123.jpg)
123
![Page 124: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/124.jpg)
124
![Page 125: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/125.jpg)
125
![Page 126: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/126.jpg)
126
![Page 127: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/127.jpg)
127
![Page 128: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/128.jpg)
128
![Page 129: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/129.jpg)
129
![Page 130: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/130.jpg)
130
![Page 131: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/131.jpg)
131
![Page 132: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/132.jpg)
132
![Page 133: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/133.jpg)
133
![Page 134: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/134.jpg)
134
![Page 135: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/135.jpg)
135
![Page 136: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/136.jpg)
136
![Page 137: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/137.jpg)
CASE # 2
Chronic IVC Occlusion
![Page 138: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/138.jpg)
This cavogram was performed by one of my colleagues and he called me for a consult
![Page 139: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/139.jpg)
Patient History: A“prophylactic” IVC filter was placed prior to a total knee
replacement in 2008
• The patient developed extensive bilateral lower extremity edema starting in 2010
![Page 140: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/140.jpg)
I ordered a CT scan for planning
![Page 141: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/141.jpg)
![Page 142: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/142.jpg)
Recanalization of the chronically occluded IVC was scheduled.
Right CFV and Right IJ were accessed in preparation to recanalyze the cava
![Page 143: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/143.jpg)
![Page 144: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/144.jpg)
![Page 145: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/145.jpg)
![Page 146: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/146.jpg)
![Page 147: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/147.jpg)
![Page 148: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/148.jpg)
![Page 149: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/149.jpg)
![Page 150: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/150.jpg)
![Page 151: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/151.jpg)
From Tree Trunks To
Chicken Legs
![Page 152: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/152.jpg)
Caval Thrombosis
![Page 153: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/153.jpg)
153
Management of a patient with an occluded Trapease filter and significant lower extremity swelling and edema.
![Page 154: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/154.jpg)
154
Bilateral iliac stent placement and high pressure angioplasty of the occluded filter
![Page 155: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/155.jpg)
155
4 months later patient swelling/edema still not resolved
![Page 156: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/156.jpg)
156
Placement of Palmaz stent through the occluded Trapease filter
![Page 157: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/157.jpg)
157
Sequential high pressure angioplasty with 16mm & 20mm Atlas balloons
![Page 158: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/158.jpg)
158
Completion cavagram of patent Palmaz stent and a Meridian IVC filter placed above for continued thromboembolic protection
![Page 159: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/159.jpg)
159
What really happens to the crushed Trapease Filter ?
![Page 160: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/160.jpg)
160
![Page 161: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/161.jpg)
161
![Page 162: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/162.jpg)
( Angiovac &Penumbra CAT 8)
Caval Thrombosis
![Page 163: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/163.jpg)
60 y/o male has a retrievable IVC filter, presented with caval thrombosis and bilateral leg swelling.72 hours post TPA thrombolysis performed using Ekos catheters (Ultrasound enhanced thrombolysis catheter) showed improvement but still with significant residual IVC clots
![Page 164: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/164.jpg)
164
![Page 165: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/165.jpg)
165
![Page 166: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/166.jpg)
166
![Page 167: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/167.jpg)
167
![Page 168: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/168.jpg)
168
![Page 169: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/169.jpg)
169
![Page 170: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/170.jpg)
170
![Page 171: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/171.jpg)
A Greenfiled filter complication case from last month
171
![Page 172: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/172.jpg)
57-year-old male with a prior history of DVT and PE status post Greenfield IVC filter placement 7 years ago.
Patient with extensive bilateral lower extremity edema, 3+ pitting edema and arteriovenous malformation which is very complex involving the iliac arteries and veins as well as contribution from the femoral artery on the left.
He has undergone 2 prior glue embolizations of these AVMs. Of note, he has IVC occlusion from the IVC filter and is very well collateralized with hypertrophied collaterals from the iliac veins. However, he has a enlarging 6.5 cm left external iliac venous aneurysm. It was felt that this may decompress somewhat after the glue embolization of the pelvic AVM but it has not as there continues to be arterialized flow through the venous system as there are multiple branches contribute into the AVM which cannot be successfully embolized. The plan is to perform renal field filter extraction with possible reconstruction of the IVC to decompress the venous outflow and hopefully relieve tension on the venous aneurysm and also help with the patient's bilateral lower extremity edema.
172
![Page 173: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/173.jpg)
173
![Page 174: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/174.jpg)
174
![Page 175: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/175.jpg)
175
In Conclusion:
When you are placing an IVC filter you are ethically, legally, financially liable and
responsible for patient outcomes…. so just be careful!!!
![Page 176: TIPS AND TRICKS FOR CHALLENGING & COMPLEX IVC FILTER …](https://reader034.vdocument.in/reader034/viewer/2022051204/6277fca587f368259160d20a/html5/thumbnails/176.jpg)
THANK YOU
176