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R9 > Chapter 152 - Vena cava interruption > Flashcards

Chapter 152 - Vena cava interruption Flashcards

1
Q

First femoral vein ligation for VTE

A

1784 John Hunter

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2
Q

First ligation of IVC for VTE to prevent PE

A

1893 Bottini

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3
Q

Mobin-Uddin umbrella

A

1867 first IVC filter

silicone membrane with hole to allow blood flow

high IVC thrombosis rate

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4
Q

Greenfiled filter types and year of developent

A

1973 - original stainless steel
1989 - titanium
1995 - low profile stainless steel

most extensively studied filter

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5
Q

IVC filter design categories

A

1) Permanent - maximize secure fixation
2) Temporary filter - no fixation, needs wire or catheter to stay transcutaneous while its in
3) Convertible filter - can convert to a non-filtering state to remove the filter
4) Optional/retrievable filter - added features to allow removal

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6
Q

Stainless steel Greenfield filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Boston
Stainless steel
Conical single tapper
Fem/jug
12F
38mm
49mm
permanent
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7
Q

Titanium Greenfield filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Boston
Titanium
Conical single tapper
Fem/jug
12F
28 mm
47 mm
permanent
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8
Q

Simon nitinol filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Bard
Nitinol
conical bilevel
fem/jug/antecubital
7F
28 mm
38 mm
permanent
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9
Q

Denali

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Bard
Nitinol
conical bilevel
fem/jug
8.4F
28 mm
50 mm
permanent/optional
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10
Q

Vena Tech LP filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
B. Braun/Vena Tech
Phynox
conical single trap
fem/jug
7F
28 mm
43 mm
permanent
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11
Q

Vena Tech convertible

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
B Braun/Vena Tech
Phynox
conical single trap
fem/jug
12.9 F
28 mm
- missing
permanent
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12
Q

TrapEase Filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Cordis
nitinol
double basket
fem/jug/antecubital
6F
30 mm
50 mm
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13
Q

OptEase filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Cordis
Nitinol
double basket
fem/jug/antecubital
6F
30 mm
54 mm
permanent/optional
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14
Q

Bird’s nest filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Cook
Stainless steel
variable
fem/jug
12F
40 mm
80 mm
permanent
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15
Q

Günter Tulip

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Cook
Conichrome
conical single trap
fem/jug
8.5F fem/7F jug
30 mm
50 mm
permanent/optional
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16
Q

Celect platinum

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Cook
Conichrome
conical single trap
fem/jug
7F
30 mm
51 mm
permanent/optional
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17
Q

ALN optional filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
ALN
stainless steel
conical
fem/jug/brachial
7F
28 mm
55 mm
permanent/optional
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18
Q

Option Elite

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Argon medical
nitinol
conical
fem/jug/antecubital/popliteal
6.5F
30 mm
56.5 mm
permanent/optional
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19
Q

Crux vena cava filter

Manufacturer
Material
Design shape
Approach
Delivery catheter size
Maximum caval diameter
Maximum deployed length
Design category
A 
Philips volcano
nitinol
helical
fem/jug
9F
17-28 mm
depends on IVC diameter
permanent/optional
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20
Q

IVC filter design that allow the least flow reduction with trapping clot

A

Single level conical design

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21
Q

Balance between self-centering and leg penetration

A

Self-centering requires more hooks

more hooks results in higher chance of leg penetration or incorporation

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22
Q

Evidence based guidelines for IVC insertion

CHEST guidelines

A

1) VTE with contraindication to AC
2) VTE with complications of AC
3) recurrent PE despite therapeutic AC
4) VTE with inability to achieve AC therapeutic level

23
Q

Relative indications for IVC insertion without hard evidence

A 
1) poor compliance of AC
2 free floating iliocaval thrombus
3) RCC with renal vein extension
4) thrombolysis/thrombectomy
5) VTE with limited cardiopulm reserve
6) VTE with high risk of AC complication
7) recurrent PE with pulm HTN
8) VTE in cancer, burn, pregnancy
9) VTE prophylaxis in high risk patients
24
Q

Contraindication to IVC filter

A

1) chronically occluded VC
2) VC anomalies
3) inability to access VC
4) VC compression
5) no location for placement

25
Q

VTE prophylaxis in high risk patients that may need IVC

A

1) high risk medical patient
2) high risk trauma patient
3) high risk bleeding patient

26
Q

Complication with IVC filter for PE

A

2-5%

fatal 0.7%

27
Q

Mortality from insertion of IVC filter

A

0.12%

28
Q

Filter insertion complications

A

1) access site thrombosis 2-28%
2) migration 3-69%
3) VC penetration 9-24%
4) VC obstruction 6-30%
5) venous insufficiency 5-59%
6) filter fracture 1%
7) guide wire entrapment 1%

29
Q

PREPIC prevention of recurrent PE by VC interruption

A

1) 400 patients with proximal DVT
2) heparin vs enox
3) +/- filter
4) lower PE with filter 12 days
5) higher DVT with filter 2 years
6) no difference in PTS

30
Q

PREPIC-2 trial

A

1) hospitalized patients with acute PE
2) retrievable filter + AC vs AC alone
3) no difference in recurrent PE

31
Q

Retrieval time for Gunther Tulip
OptEase
Celect

A

Gunther tulip 20 days
OptEAse 14 days
Celect 52 weeks

32
Q

Rate of success filter retrieval at 1 3 and 12 months

A

1 month 99%
3 months 94%
12 months 37%

33
Q

Indication for using retrievable filters

A

1) no indication for permanent filter
2) risk of PE low
3) return to high risk VTE not anticipated
4) life expectancy long enough to see benefit of removal
5) filter can be removed safely

34
Q

IVC filter placement in pregnant patient special considerations

A

Place in suprarenal IVC due to compression in third trimester
also IJ approach safer

35
Q

Segments of the IVC anatomy

A

1) hepatic
2) suprarenal
3) renal
4) infrarenal

36
Q

Origin of the IVC level

A

Confluence of iliac veins at L4, L5

37
Q

Renal veins drain into IVC at this level

A

L1-L2

38
Q

Which renal vein is more cephalic

A

Left renal

39
Q

Left gonadal vein drains into

A

Left renal vein

40
Q

Right gonadal vein drains into

A

Right renal vein or IVC

41
Q

IVC in relation to pancreas

A

posterior to head of pancreas and posterior to liver

42
Q

Where do the hepatic veins join IVC

A

Join at the infrahepatic VC before going under right crus

43
Q

Hepatic veins names

A

1) left
2) middle
3) right
4) caudate

44
Q

IVC anomalies

A

1) Renal vein anomalies 5-7% (retroaortic or circumaortic left renal vein, multiple renal veins)
2) IVC transposition 0.2-0.5%; left IVC drains to left renal vein then crosses to right IVC
3) duplication IVC: 0.2-0.3%; left usually smaller and joins left renal vein to drain into right IVC
4) IVC agenesis: renal segment of IVC drain into azygos system and right atrium via SVC

45
Q

IVC agenesis associated with

A

1) Dextrocardia
2) atrial septal defect
3) pulmonary artery stenosis
4) visceral anomalies

46
Q

IVC agenesis embryology failure

A

Right subcardinal vein fail to anastomose with hepatic sinusoid

47
Q

Imaging modality to guide IVC filter placement

A

1) venography
2) IVUS
3) transabdominal US

48
Q

Additional techniques to free up IVC attachments in retrieval

A

1) sheathing
2) balloon dislodgment
3) snare
4) bronchoscopic forceps

49
Q

Risk of PE with UEDVT

A

5-10%

50
Q

Special considerations for SVC filter insertion

A

1) have to flip the jug/ij device use

2) only IVC filters available for use

51
Q

Rate of duplicated SVC

A

0.1-0.3%

52
Q

Cut off size of SVC for filter insertion

A

28 mm

53
Q

Indication for SVC filter insertion

A

1) UEDVT

2) anticoagulation not possible

R9 (200 decks)

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