Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration.
PURPOSE
The purpose of the study is to evaluate the influence of respiratory-induced vena caval hemodynamic changes on filter migration/penetration.


MATERIALS AND METHODS
After placement of either a Gunther Tulip or Celect IVC filter, 101 consecutive patients scheduled for filter retrieval were prospectively enrolled in this study. Pre-retrieval CT scans were used to assess filter complications and to calculate cross-sectional area in three locations: at level of filter strut fixation, 3 cm above and 3 cm below. A 3D finite element simulation was constructed on these data and direct IVC pressure was recorded during filter retrieval. Cross-sectional areas and pressures of the vena cava were measured during neutral breathing and in Valsalva maneuver and identified filter complications were recorded. A statistical analysis of these variables was then performed.


RESULTS
During Valsalva maneuvers, a 60 % decrease of the IVC cross-sectional area and a fivefold increase in the IVC pressure were identified (p < 0.001). There was a statistically significant difference in the reduction of the cross-sectional area at the filter strut level (p < 0.001) in patient with filter penetration. Difficulty in filter retrieval was higher in penetrated or tilted filters (p < 0.001; p = 0.005). 3D computational models showed significant IVC deformation around the filter during Valsalva maneuver.


CONCLUSION
Caval morphology and hemodynamics are clearly affected by Valsalva maneuvers. A physiological reduction of IVC cross-sectional area is associated with higher risk of filter penetration, despite short dwell times. Physiologic data should be used to improve future filter designs to remain safely implanted over longer dwell times.
['Laborda|Alicia|A|', 'Kuo|William T|WT|', 'Ioakeim|Ignatios|I|', 'De Blas|Ignacio|I|', 'Malvè|Mauro|M|', 'Lahuerta|Celia|C|', 'De Gregorio|Miguel A|MA|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D020878:Device Removal D005260:Female D005548:Foreign-Body Migration D006439:Hemodynamics D006801:Humans D007091:Image Processing, Computer-Assisted D021621:Imaging, Three-Dimensional D008297:Male D008875:Middle Aged D015641:Radiography, Interventional D012119:Respiration D012307:Risk Factors D014057:Tomography, X-Ray Computed D014636:Valsalva Maneuver D016306:Vena Cava Filters D014682:Vena Cava, Inferior D055815:Young Adult
Penetration Complications Valsalva maneuver Deep vein thrombosis Vena cava filter