Published online before print September 27, 2002, 10.1148/radiol.2252011825
Initial Experience in Humans with a New Retrievable Inferior Vena Cava Filter1
Murray R. Asch, MD, FRCPC
1 From the Department of Medical Imaging, Mount Sinai Hospital/University Health Network, 600 University Ave, Suite 564, Toronto, Ontario, Canada M5G 1X5. From the 2001 RSNA scientific assembly. Received November 14, 2001; revision requested January 29, 2002; revision received March 12; accepted June 26. Supported in part by NMT Medical and C. R. Bard. Address correspondence to the author (e-mail: masch@mtsinai.on.ca).
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Figure 1. RNF retrievable IVC filter. (Original magnification, x3.) The device is manufactured from nitinol wire of 0.013 inch in diameter. It is 4 cm in height, and the base can accommodate a vena cava up to 28 mm in diameter. There is dual-level filtration from both the arms and the legs.
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Figure 2a. Vena cavograms depict filter placement. (a) Frontal scout view obtained just before the postinsertion vena cavogram shows the highly visible nitinol RNF filter with its tip at the L1-2 interspace (black arrow). Note the radiopaque marker band on the tip of the insertion sheath (white arrow). (b) Frontal postinsertion vena cavogram demonstrates that the filter is aligned with the caval axis, with its tip approximately 1 cm caudal to the right renal vein (arrow). (c) Lateral vena cavogram demonstrates alignment in this plane as well.
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Figure 2b. Vena cavograms depict filter placement. (a) Frontal scout view obtained just before the postinsertion vena cavogram shows the highly visible nitinol RNF filter with its tip at the L1-2 interspace (black arrow). Note the radiopaque marker band on the tip of the insertion sheath (white arrow). (b) Frontal postinsertion vena cavogram demonstrates that the filter is aligned with the caval axis, with its tip approximately 1 cm caudal to the right renal vein (arrow). (c) Lateral vena cavogram demonstrates alignment in this plane as well.
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Figure 2c. Vena cavograms depict filter placement. (a) Frontal scout view obtained just before the postinsertion vena cavogram shows the highly visible nitinol RNF filter with its tip at the L1-2 interspace (black arrow). Note the radiopaque marker band on the tip of the insertion sheath (white arrow). (b) Frontal postinsertion vena cavogram demonstrates that the filter is aligned with the caval axis, with its tip approximately 1 cm caudal to the right renal vein (arrow). (c) Lateral vena cavogram demonstrates alignment in this plane as well.
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Figure 3. Retrieval cone, which is constructed with nine metal claws covered by a urethane cover. The open diameter of the cone is 15 mm. A central lumen allows for over-the-wire placement. The cone is inserted via the jugular vein through a 10-F profile catheter with a radiopaque band on its end.
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Figure 4. Follow-up transverse contrast material-enhanced spiral computed tomographic (CT) scan obtained as part of this patient’s routine medical care 2 weeks after placement of an RNF shows the filter to be in good position, with no associated complication.
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Figure 5a. Thrombus removal. (a) Vena cavogram obtained with a 5-F multipurpose catheter inserted via the right internal jugular vein at the time of filter removal (10 days after placement) reveals a small trapped embolus within the filter (arrow). (b) Gross specimen obtained after removal of filter and embolus with a standard 10-F sheath. Note embolus trapped by filter legs.
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Figure 5b. Thrombus removal. (a) Vena cavogram obtained with a 5-F multipurpose catheter inserted via the right internal jugular vein at the time of filter removal (10 days after placement) reveals a small trapped embolus within the filter (arrow). (b) Gross specimen obtained after removal of filter and embolus with a standard 10-F sheath. Note embolus trapped by filter legs.
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Figure 6a. Filter migration and clot capture. (a) Abdominal radiograph obtained 1 day after filter placement shows that the filter tip is at the level of the pedicle of L1 (arrow). The surgical clips are from vascular repair after coronary artery stent placement, which was performed prior to filter placement. (b) Routine abdominal radiograph obtained 5 days after filter placement shows that the filter tip is now at the level of the pedicle of T12 (arrow). (c) Vena cavogram obtained at the time of planned filter removal 17 days after placement shows a large embolus within the filter (arrow). Note flow defect from left renal vein. (d) Frontal image shows that the 10-F removal sheath (curved arrow) has been advanced over an Amplatz wire and inserted through a 20-F vascular sheath (straight arrow) for filter retrieval. (e) Gross specimen of filter and trapped clot. The filter deformity occurred at the time of removal from the sheath.
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Figure 6b. Filter migration and clot capture. (a) Abdominal radiograph obtained 1 day after filter placement shows that the filter tip is at the level of the pedicle of L1 (arrow). The surgical clips are from vascular repair after coronary artery stent placement, which was performed prior to filter placement. (b) Routine abdominal radiograph obtained 5 days after filter placement shows that the filter tip is now at the level of the pedicle of T12 (arrow). (c) Vena cavogram obtained at the time of planned filter removal 17 days after placement shows a large embolus within the filter (arrow). Note flow defect from left renal vein. (d) Frontal image shows that the 10-F removal sheath (curved arrow) has been advanced over an Amplatz wire and inserted through a 20-F vascular sheath (straight arrow) for filter retrieval. (e) Gross specimen of filter and trapped clot. The filter deformity occurred at the time of removal from the sheath.
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Figure 6c. Filter migration and clot capture. (a) Abdominal radiograph obtained 1 day after filter placement shows that the filter tip is at the level of the pedicle of L1 (arrow). The surgical clips are from vascular repair after coronary artery stent placement, which was performed prior to filter placement. (b) Routine abdominal radiograph obtained 5 days after filter placement shows that the filter tip is now at the level of the pedicle of T12 (arrow). (c) Vena cavogram obtained at the time of planned filter removal 17 days after placement shows a large embolus within the filter (arrow). Note flow defect from left renal vein. (d) Frontal image shows that the 10-F removal sheath (curved arrow) has been advanced over an Amplatz wire and inserted through a 20-F vascular sheath (straight arrow) for filter retrieval. (e) Gross specimen of filter and trapped clot. The filter deformity occurred at the time of removal from the sheath.
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Figure 6d. Filter migration and clot capture. (a) Abdominal radiograph obtained 1 day after filter placement shows that the filter tip is at the level of the pedicle of L1 (arrow). The surgical clips are from vascular repair after coronary artery stent placement, which was performed prior to filter placement. (b) Routine abdominal radiograph obtained 5 days after filter placement shows that the filter tip is now at the level of the pedicle of T12 (arrow). (c) Vena cavogram obtained at the time of planned filter removal 17 days after placement shows a large embolus within the filter (arrow). Note flow defect from left renal vein. (d) Frontal image shows that the 10-F removal sheath (curved arrow) has been advanced over an Amplatz wire and inserted through a 20-F vascular sheath (straight arrow) for filter retrieval. (e) Gross specimen of filter and trapped clot. The filter deformity occurred at the time of removal from the sheath.
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Figure 6e. Filter migration and clot capture. (a) Abdominal radiograph obtained 1 day after filter placement shows that the filter tip is at the level of the pedicle of L1 (arrow). The surgical clips are from vascular repair after coronary artery stent placement, which was performed prior to filter placement. (b) Routine abdominal radiograph obtained 5 days after filter placement shows that the filter tip is now at the level of the pedicle of T12 (arrow). (c) Vena cavogram obtained at the time of planned filter removal 17 days after placement shows a large embolus within the filter (arrow). Note flow defect from left renal vein. (d) Frontal image shows that the 10-F removal sheath (curved arrow) has been advanced over an Amplatz wire and inserted through a 20-F vascular sheath (straight arrow) for filter retrieval. (e) Gross specimen of filter and trapped clot. The filter deformity occurred at the time of removal from the sheath.
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Figure 7a. Sequence of vena cavograms illustrates the technique of removing a filter with a wire. (a) The retrieval cone is advanced over a wire, (b) the filter arms are engaged, and (c) the filter is retrieved.
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Figure 7b. Sequence of vena cavograms illustrates the technique of removing a filter with a wire. (a) The retrieval cone is advanced over a wire, (b) the filter arms are engaged, and (c) the filter is retrieved.
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Figure 7c. Sequence of vena cavograms illustrates the technique of removing a filter with a wire. (a) The retrieval cone is advanced over a wire, (b) the filter arms are engaged, and (c) the filter is retrieved.
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Copyright © 2002 by the Radiological Society of North America.
