Inferior vena cava filter

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Inferior vena cava filter
Inferior vena cava filter.jpg
Inferior vena cava filter - Gunther Tulip. [1]
Other namesIVC filter
Specialty Cardiovascular

An inferior vena cava filter is a medical device made of metal that is implanted by vascular surgeons or interventional radiologists into the inferior vena cava to prevent a life-threatening pulmonary embolism (PE) or venous thromboembolism (VTE). [2] [3]

Contents

The filter is designed to trap a blood clot and prevent its travel to the lung where it would form a pulmonary embolism. [4] [3] Their effectiveness and safety profile is well established, and they may be used when anticoagulant treatment is not sufficient. [5]

Results from the PREPIC study and other studies which have shown many long-term complications of IVC filters led to the introduction of retrievable IVC filters. [6] The first retrievable IVC filters were approved by FDA in 2003 and 2004. [7]

In 2012, the American College of Chest Physicians recommended IVC filters for those with contraindications to anticoagulation who either have acute PE or acute proximal deep vein thrombosis (above the knee). [8] [9]

History

Image showing an inferior vena cava filter in its position 3D Medical Animation Inferior Vena Filter.jpg
Image showing an inferior vena cava filter in its position

The first IVC filter was created by Kazi Mobin-Uddin who published his findings in 1969 in the New England Journal of Medicine. [10] [11] [12] [13] The Mobin-Uddin filter was later replaced by the Greenfield filter developed by Lazar Greenfield which had a lower rate of filter related complications. [12]

Medical uses

Inferior vena cava filter as seen on plain X ray of the abdomen IVCFilterMark.png
Inferior vena cava filter as seen on plain X ray of the abdomen

While the ability to retrieve a filter does exist for many models, it cannot be guaranteed that all cases of filter placement will allow for, or be indicated for retrieval. Thus, the requirements and indications for permanent placement of filters is used to decide on when to use both permanent and temporary IVC filters. [14]

Long-term risk factors must be considered as well, to include life expectancy of more than six months following insertion, and the ability of the patient to comply with anticoagulation therapy. [5] The decision to use a filter that is temporary vs permanent basically is tied to the expected duration of time that protection is needed to prevent pulmonary emboli from passing to the heart and lungs. One such guideline is outlined below: [14]

Indication categories

While many studies have been done on the efficacy of Vena Cava filters, there still have not been any major studies done on the actual placement and removal of the filters regarding standard guidelines. Which is why the Society of Interventional Radiology created a multidisciplinary panel that developed the following guidelines to see if someone qualifies for implantation:[ citation needed ]

Absolute indications

These are patients that should strongly consider having IVC filter placement, as they are at greatest risk of pulmonary embolus.

  • Proven VTE: Venous thromboembolism and contraindication or complication due to anticoagulation therapy
  • Recurrent VTE: Despite adequate anticoagulation therapy

Relative indications

This is a maybe category; normally it represents patients who could benefit from an IVC filter, but may be just fine without one as well.[ citation needed ]

  • Proven VTE: High risk of contraindication or complication to arise during anticoagulation therapy
  • Large, free-floating proximal DVTs
  • Poor compliance: INR levels are not stable, not taking medicine as directed
  • Thrombolysis: Iliocaval DVT's, which are emboli in the Illiac region

Prophylactic indications

These are usually very controversial reasons to do an IVC filter, and most radiologists and doctors generally will not recommend an IVC filter if other options are available instead.

  • No VTE: Anticoagulation therapy is not possible (high risk of bleeding)
  • Transient risk of VTE: Trauma, surgical procedures or medical conditions

Other indications

  • Bariatric patients: Undergoing surgery for weight control, only if BMI greater than 55, previous history of DVT/PE, hypercoagulable state, chronic venous insufficiency, truncal obesity or contraindication to anticoagulation therapy. [15]

Indications for removing IVC filter

There is no current published data confirming the benefit of removing an IVC. Because of this, the Society of Interventional Radiology created a multidisciplinary panel that developed the following guidelines to see if someone qualifies for removal: [5]

An IVC filter, just by doing its job properly (catching embolic material), can eventually fill up with embolic material and cause a circulatory impairment that may warrant revision with vascular surgery (new filter, stent additions, or otherwise). A representative case has been reported in science journalism of the type that reports interesting unusual causes and solutions of symptoms; [16] in this instance, the symptom was orthostatic hypotension. [16] Physicians speculate that this problem is uncommon but nonetheless worth consideration in differential diagnosis. [16]

Anticoagulation

In those with initial acute proximal DVT or acute PE who had IVC filters placed instead of anticoagulation, and who have their risk of bleeding resolve, the American College of Chest Physicians suggested, in 2012, that they receive a standard course of anticoagulation. [8] [9] While IVC filters are associated with a long term risk of DVT, [17] they are not, alone, reason enough to maintain extended anticoagulation. [8] [9]

Side effects

The main function of a vena cava filter is to prevent death from massive pulmonary emboli. Long-term clinical follow-up studies have shown that this is accomplished in 96% of cases having a standard stainless-steel Greenfield filter. [18]

Abdominal radiograph shows that one of the legs (arrows) of the IVC filter is pointed away from the expected IVC lumen. Radiograph showing IVC Filter Fracture.jpg
Abdominal radiograph shows that one of the legs (arrows) of the IVC filter is pointed away from the expected IVC lumen.
Axial CT image confirms that one of the legs (arrow) of the IVC filter has migrated out of the IVC wall into an adjacent tissue. CT showing IVC Filter Fracture.jpg
Axial CT image confirms that one of the legs (arrow) of the IVC filter has migrated out of the IVC wall into an adjacent tissue.

FDA communication

In August, 2010, the FDA released an Initial Communication on the Risk and Adverse events associated with Long Term use of an inferior vena cava filter. [19] Over a period of about 5 years, they identify 921 events. While not the majority of cases, that number still represents a statistical significance of the use of long-term IVCs.

Of these IVC filter side effects, 328 involved device migration, 146 involved embolizations after detachment of device components, 70 involved perforation of the IVC, and 56 involved filter fracture. Much of the medical community believes that this large number of adverse events is related to the heart filter remaining in place for longer than necessary.

Common issues relating to failure, to include death (the other 4% of cases) include:

Less common adverse reactions

While these side effects are not common (less than 10-20% of patients), many do report issues stemming from the placement and complication of the IVC while inside of the body. [20]

Numerous small published articles and case studies report describe similar issues to the above. Most notably:

Even though the cases above are the exception, and not the rule, most radiologists object to doing prophylactic filter insertions in patients who do not have thromboembolic diseases. [32] For the most part, whenever possible, interventional radiologists would rather start the patient on anticoagulants than use an IVC, even if requested or referred via a doctor. [33]

MRI

While most IVC filters are made of non-ferromagnetic materials, there are a few types that are weakly ferromagnetic. Accordingly, IVC filters fall under the MRI Safe and MRI Conditional categories depending mostly on type of material used during construction. Rarely will one find an MRI Not Safe IVC filter, as most of the steel, and other ferromagnetic material devices have been discontinued via the FDA.[ citation needed ]

IVC filters are attached to the vena cava via hooks on their ends. Some are compression springs, which compress outward onto the side wall of the vena cava; however, they still have small hooks that retain their location. These hooks aid in the anchoring and healing process, as they allow the tissues to 'ingrow' around them, securing the IVC in place. It is unlikely, then, after 4 to 6 weeks of healing, that an MRI of 1.5 tesla, up to 3 tesla, will cause any level of dislodging to occur to the IVC filter.[ citation needed ]

Studies of MR examination of both animals and humans, with implanted IVC filters, have not reported complications or symptomatic filter displacement. [34] [35] [36] [37] [38] [39]

Several animal studies have even used "real-time" MR for the placement of IVC filters to check for rotation, sheering, and other artifacts. [40] [41]

As part of the 'routing' survey for MRI studies, patients who have IVC filters will often need verification from the doctor, or medical records, to state that the IVC is safe for the MRI. Most patients with weakly or non-safe ferromagnetic implants will be given a card, which they keep on their person at all time, that can help isolate if it is safe to do an MRI.

For patients who have been denied MRI scans for safety reasons, doctors usually recommend the CT scan with contrast as an alternative.

Labeling and recommendations

Most IVC filters that have been tested have been labeled as “MRi safe”; the remainder of IVC filters that have been tested are “MR conditional.” Patients who have been treated with nonferromagnetic IVC filters can undergo MR examination any time after filter implantation. In patients who have been treated with a weakly ferromagnetic IVC filter (Gianturco bird nest IVC filter [Cook], stainless steel Greenfield vena cava filter [Boston Scientific]), it is advised that the patient wait at least six weeks before undergoing an MR examination (because these older devices initially may not be anchored as firmly in place as other devices discussed in the present context), unless there is a strong clinical indication to perform the MR examination sooner after implantation, and as long as there is no reason to suspect that the device is not positioned properly or that it is not firmly in place. Most studies of IVC filters have generally been conducted at 1.5 tesla or less, although many IVC filters have now been evaluated at 3 tesla and deemed acceptable for MR examination. [42] [43]

Placement

IVC filters are placed endovascularly, meaning that they are inserted via the blood vessels. Historically, IVC filters were placed surgically, but with modern filters that can be compressed into much thinner catheters, access to the venous system can be obtained via the femoral vein (the large vein in the groin), the internal jugular vein (the large vein in the neck) or the arm veins with one design. Choice of route depends mainly on the number and location of any blood clot within the venous system. To place the filter, a catheter is guided into the IVC using fluoroscopic guidance, then the filter is pushed through the catheter and deployed into the desired location, usually just below the junction of the IVC and the lowest renal vein. [44]

Review of prior cross-sectional imaging or a venogram of the IVC is performed before deploying the filter to assess for potential anatomic variations, thrombi within the IVC, or areas of stenoses, as well as to estimate the diameter of the IVC. Rarely, ultrasound-guided placement is preferred in the setting of contrast allergy, chronic kidney disease, and when patient immobility is desired. The size of the IVC may affect which filter is deployed, as some (such as the Birds Nest) are approved to accommodate larger cavae. There are situations where the filter is placed above the renal veins (e.g. pregnant patients or women of childbearing age, renal or gonadal vein thromboses, etc.). Also, if there is duplication of the IVC, the filter is placed above the confluence of the two IVCs [45] or a filter can be placed within each IVC. [46]

Retrieval

The concept of a removable IVC filter was first conceived in 1967. [47] In 2003 and 2004 that the United States Food and Drug Administration first approved retrievable filters. [48] In 2005 that the Society of Interventional Radiology (SIR) convened a multidisciplinary conference to address the clinical application of nonpermanent vena cava filters.[ citation needed ]

Retrievable filters are fitted with a device (varying from model to model) that allows them to be easily snared and pulled back into a catheter and removed from the body, often through the jugular vein. Prior to 2004, filters that had been in the IVC for less than three weeks were considered suitable to attempt retrieval, as filters that have been in place longer might have been overgrown by cells from the IVC wall and there was an increased risk of IVC injury if the filter is dislodged. Newer designs, and developments in techniques mean that some filters can now be left in for prolonged periods and retrievals after a year are now being reported. [49] This would include the ALN, Bard G2 and G2x, Option, Tulip and Celect filters.[ citation needed ]

It is important to note that the clinical exam prior to the removal of the filter is vital in understanding both the risk and pathophysiological effects removing the filter will have on the patient. Doctors and medical professionals must consider several key factors (see Indications for removing IVC filters).[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in the circulatory system of humans and most other animals that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Thrombosis</span> Medical condition caused by blood clots

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus.

<span class="mw-page-title-main">Pulmonary embolism</span> Blockage of an artery in the lungs

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, obstructive shock, and sudden death.

<span class="mw-page-title-main">Venous thrombosis</span> Blood clot (thrombus) that forms within a vein

Venous thrombosis is the blockage of a vein caused by a thrombus. A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to lodge there, it becomes a pulmonary embolism (PE), a blood clot in the lungs. The conditions of DVT only, DVT with PE, and PE only, are all captured by the term venous thromboembolism (VTE).

<span class="mw-page-title-main">Inferior vena cava</span> One of two veinous trunks bringing deoxygenated blood back to the heart

The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.

<span class="mw-page-title-main">Deep vein thrombosis</span> Formation of a blood clot (thrombus) in a deep vein

Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. The most common life-threatening concern with DVT is the potential for a clot to embolize, travel as an embolus through the right side of the heart, and become lodged in a pulmonary artery that supplies blood to the lungs. This is called a pulmonary embolism (PE). DVT and PE comprise the cardiovascular disease of venous thromboembolism (VTE). About two-thirds of VTE manifests as DVT only, with one-third manifesting as PE with or without DVT. The most frequent long-term DVT complication is post-thrombotic syndrome, which can cause pain, swelling, a sensation of heaviness, itching, and in severe cases, ulcers. Recurrent VTE occurs in about 30% of those in the ten years following an initial VTE.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Azygos vein</span> Human blood vessel by the spine

The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood to the right atrium when either of the venae cavae is blocked.

<span class="mw-page-title-main">Fontan procedure</span> Surgical procedure used in children with univentricular hearts

The Fontan procedure or Fontan–Kreutzer procedure is a palliative surgical procedure used in children with univentricular hearts. It involves diverting the venous blood from the inferior vena cava (IVC) and superior vena cava (SVC) to the pulmonary arteries. The procedure varies for differing congenital heart pathologies. For example in tricuspid atresia, the procedure can be done where the blood does not pass through the morphologic right ventricle; i.e., the systemic and pulmonary circulations are placed in series with the functional single ventricle. Whereas in hypoplastic left heart syndrome, the heart is more reliant on the more functional right ventricle to provide blood flow to the systemic circulation. The procedure was initially performed in 1968 by Francis Fontan and Eugene Baudet from Bordeaux, France, published in 1971, simultaneously described in 1971 by Guillermo Kreutzer from Buenos Aires, Argentina, and finally published in 1973.

<span class="mw-page-title-main">Inferior vena cava syndrome</span> Medical condition

Inferior vena cava syndrome (IVCS) is a very rare constellation of symptoms resulting from either an obstruction, or stenosis of the inferior vena cava. It can be caused by physical invasion or compression by a pathological process or by thrombosis within the vein itself. It can also occur during pregnancy. Pregnancy leads to high venous pressure in the lower limbs, decreased blood return to the heart, decreased cardiac output due to obstruction of the inferior vena cava, sudden rise in venous pressure which can lead to placental separation, and a decrease in kidney function. All of these issues can arise from lying in the supine position during late pregnancy which can cause compression of the inferior vena cava by the uterus. Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, hypotension, and fluid retention.

<span class="mw-page-title-main">Paget–Schroetter disease</span> Medical condition

Paget–Schroetter disease is a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axillary and/or subclavian veins.

<span class="mw-page-title-main">Post-thrombotic syndrome</span> Medical condition

Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT).

<span class="mw-page-title-main">Venous stasis</span> Medical condition

Venous stasis, or venostasis, is a condition of slow blood flow in the veins, usually of the legs.

<span class="mw-page-title-main">Congenital stenosis of vena cava</span> Medical condition

Congenital stenosis of vena cava is a congenital anomaly in which the superior vena cava or inferior vena cava has an aberrant interruption or coarctation.

<span class="mw-page-title-main">Superficial thrombophlebitis</span> Medical condition

Superficial thrombophlebitis is a thrombosis and inflammation of superficial veins which presents as a painful induration with erythema, often in a linear or branching configuration forming cords.

<span class="mw-page-title-main">Intermittent pneumatic compression</span>

Intermittent pneumatic compression is a therapeutic technique used in medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who have edema or the risk of deep vein thrombosis (DVT), pulmonary embolism (PE), or the combination of DVT and PE which is venous thrombeombolism (VTE).

Blood clots are a relatively common occurrence in the general population and are seen in approximately 1-2% of the population by age 60. Typically, blood clots develop in the deep veins of the lower extremities, deep vein thrombosis (DVT) or as a blood clot in the lung, pulmonary embolism. A very small number of people who develop blood clots have a more serious and often life-threatening condition, known as thrombotic storm (TS). TS is characterized by the development of more than one blood clot in a short period of time. These clots often occur in multiple and sometimes unusual locations in the body and are often difficult to treat. TS may be associated with an existing condition or situation that predisposes a person to blood clots, such as injury, infection, or pregnancy. In many cases, a risk assessment will identify interventions that will prevent the formation of blood clots.

<span class="mw-page-title-main">Superficial vein thrombosis</span> Medical condition

Superficial vein thrombosis (SVT) is a blood clot formed in a superficial vein, a vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration with redness. SVT itself has limited significance when compared to a deep vein thrombosis (DVT), which occurs deeper in the body at the deep venous system level. However, SVT can lead to serious complications, and is therefore no longer regarded as a benign condition. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.

<span class="mw-page-title-main">Kazi Mobin-Uddin</span> American surgeon (1930–1999)

Kazi Mobin-Uddin was an American surgeon specializing in vascular surgery research.

<span class="mw-page-title-main">Thrombosis prevention</span> Medical treatment

Thrombosis prevention or thromboprophylaxis is medical treatment to prevent the development of thrombosis in those considered at risk for developing thrombosis. Some people are at a higher risk for the formation of blood clots than others, such as those with cancer undergoing a surgical procedure. Prevention measures or interventions are usually begun after surgery as the associated immobility will increase a person's risk.

References

  1. ↑ Gunther Tulip IVC Filter. Cook Medical. URL: http://www.cookmedical.com/di/di_front/images/dif_bu1.jpg. Accessed on: November 24, 2007.
  2. ↑ De Gregorio, MA; Guirola, JA; Sierre, S (24 December 2021). "Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism". Journal of Clinical Medicine. 11 (1): 77. doi: 10.3390/jcm11010077 . PMC   8745208 . PMID   35011826.
  3. 1 2 Young, T; Sriram, KB (8 October 2020). "Vena caval filters for the prevention of pulmonary embolism". The Cochrane Database of Systematic Reviews. 10 (12): CD006212. doi:10.1002/14651858.CD006212.pub5. PMC   8971091 . PMID   33027844.
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  12. 1 2 Galanaud JP, Laroche JP, Righini M (2013). "The history and historical treatments of deep vein thrombosis". Journal of Thrombosis and Haemostasis. 11 (3): 402–11. doi: 10.1111/jth.12127 . PMID   23297815. S2CID   23288926.
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  18. ↑ Greenfield, LJ; Peyton R; Crute S; Barnes R (1981). "Greenfield vena caval filter experience: late results in 156 patients". Archives of Surgery. 116 (11): 1451–1456. doi:10.1001/archsurg.1981.01380230065010. PMID   7305658.
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  26. ↑ Puram, B; Maley TJ; White NM; Rotman HH; Miller G (1990). "Acute myocardial infarction resulting from the migration of a Greenfield filter". Chest. 98 (6): 1510–1511. doi:10.1378/chest.98.6.1510. PMID   2245696.
  27. ↑ Bach, JR; Zaneuski R; Lee H (1990). "Cardiac arrhythmias from a malpositioned Greenfield filter in a traumatic quadriplegic". American Journal of Physical Medicine & Rehabilitation. 69 (5): 251–253. doi:10.1097/00002060-199010000-00005. PMID   2222985. S2CID   36313307.
  28. ↑ Villard, J; Detry L; Clermont A; Pinet F (1987). "Eight cases of Greenfield filters in the right heart cavities: their surgical treatment". Annals of Radiology. 30: 102–104.
  29. ↑ Poillaud, C; Paillard F; Biron Y; Gouffault J (1988). "Proximal migration of a caval filter: apropos of a case". Annales de Cardiology et d'Angéiologie. 37: 129–131.
  30. ↑ LaPlante, JS; Contractor FM; Kiproff PM; Khoury MB (1993). "Migration of the Simon nitinol vena cava filter to the chest". American Journal of Roentgenology. 160 (2): 385–386. doi: 10.2214/ajr.160.2.8424358 . PMID   8424358.
  31. ↑ Kupferschmid, JP; Dickson CS; Townsend RN; Diamond DL (1992). "Small-bowel obstruction from an extruded Greenfield filter strut: an unusual late complication". Journal of Vascular Surgery. 16 (1): 113–115. doi: 10.1016/0741-5214(92)90427-a . PMID   1619711.
  32. ↑ Emerson, RH Jr.; Cross R; Head WC (1991). "Prophylactic and early therapeutic use of the Greenfield filter in hip and knee joint arthroplasty". Journal of Arthroplasty. 6 (2): 129–135. doi:10.1016/s0883-5403(11)80007-0. PMID   1875203.
  33. ↑ Olin, JW; Young JR; Graor RA; Ruschhaupt WF; Beven EG; Bay JW (1987). "Treatment of deep-vein thrombosis and pulmonary emboli in patients with primary and metastatic brain tumors: anticoagulants or inferior vena cava filters?". Archives of Internal Medicine. 147 (12): 2177–2179. doi:10.1001/archinte.147.12.2177. PMID   3500686.
  34. ↑ Watanabe AT, Teitelbaum GP, Gomes AS, Roehm JO Jr (1990). "MR imaging of the bird's nest filter". Radiology. 177 (2): 578–579. doi:10.1148/radiology.177.2.2217801. PMID   2217801.
  35. ↑ Kiproff PM, Deeb ZL, Contractor FM, Khoury MB (1991). "Magnetic resonance characteristics of the LGM vena cava filter: technical note". Cardiovasc Intervent Radiol. 14 (4): 254–255. doi:10.1007/bf02578474. PMID   1913742. S2CID   5815275.
  36. ↑ Kim D, Edelman RR, Margolin CJ, Porter DH, McArdle CR, Schlam BW, Gianturco LE, Siegel JB, Simon M (1992). "The Simon nitinol filter: evaluation by MR and ultrasound". Angiology. 43 (7): 541–548. doi:10.1177/000331979204300701. PMID   1626731. S2CID   33310735.
  37. ↑ Grassi CJ, Matsumoto AH, Teitelbaum GP (1992). "Vena caval occlusion after Simon nitinol filter placement: identification with MR imaging in patients with malignancy". J Vasc Interv Radiol. 3 (3): 535–539. doi:10.1016/s1051-0443(92)72008-9. PMID   1515724.
  38. ↑ Bartels LW, Bakker CJ, Viergever MA (2002). "Improved lumen visualization in metallic vascular implants by reducing RF artifacts". Magn Reson Med. 47 (1): 171–180. doi: 10.1002/mrm.10004 . PMID   11754456. S2CID   24558910.
  39. ↑ Liebman CE, Messersmith RN, Levin DN, Lu CT (1988). "MR imaging of inferior vena caval filters: safety and artifacts". American Journal of Roentgenology. 150 (5): 1174–1176. doi: 10.2214/ajr.150.5.1174 . PMID   3258722.
  40. ↑ Bucker A, Neuerburg JM, Adam GB, Glowinski A, Schaeffter T, Rasche V, van Vaals JJ, Günther RW (2001). "Real-time MR guidance for inferior vena cava filter placement in an animal model". J Vasc Interv Radiol. 12 (6): 753–756. doi:10.1016/s1051-0443(07)61448-1. PMID   11389228.
  41. ↑ Frahm C, Gehl HB, Lorch H, Zwaan M, Drobnitzky M, Laub GA, Weiss HD (1998). "MR-guided placement of a temporary vena cava filter: technique and feasibility". J Magn Reson Imaging. 8 (1): 105–109. doi:10.1002/jmri.1880080121. PMID   9500268. S2CID   30617216.
  42. ↑ MRI safety. Institute for Magnetic Resonance Safety, Education, and Research Web site. Available at: http://www.MRIsafety.com. Accessed June 19, 2006.
  43. ↑ Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices: 2006 Edition. Los Angeles, Calif: Biomedical Research Publishing Group; 2006.
  44. ↑ Kinney, Thomas; Cameron, S; Sass, P; Zoller, M; Wigler, M (1 September 2006). "Inferior Vena Cava Filters". Seminars in Interventional Radiology. 23 (3): 230–239. doi:10.1055/s-2006-948760. PMC   3036373 . PMID   21326769.
  45. ↑ Mano, Tatsumi T; Sakai H; et al. (2004). "A case of deep venous thrombosis with a double inferior vena cava effectively treated by suprarenal filter implantation". Japanese Heart Journal. 45 (6): 1063–1069. doi: 10.1536/jhj.45.1063 . PMID   15655283.
  46. ↑ Sartori, MT; Zampieri P; Andres AL; Prandoni P; Motta R; Miotto D (2006). "Double vena cava filter insertion in congenital duplicated inferior vena cava: a case report and literature review". Haematologica. 6. 91 (ECR30): ECR30. PMID   16785133.
  47. ↑ Williams R, Schenk W (1970). "A removable intracaval filter for prevention of pulmonary embolism: early experience with the use of the Eichelter catheter in patients". Surgery. 68 (6): 999–1008. PMID   5483252.
  48. ↑ Kaufman J (2004). "Retrievable vena cava filters". Tech Vasc Interv Radiol. 7 (2): 96–104. doi:10.1053/j.tvir.2004.02.006. PMID   15252767.
  49. ↑ McKenzie S, et al. (2010). "An Australian experience of retrievable inferior vena cava filters in patients with increased risk of thromboembolic disease". International Angiology. 29 (1): 53–57. PMID   20224533.


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