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Thursday, June 2, 2016

New Study Investigates Retrieval and Complication Rates of Denali and Celect IVC Filter


In an article in press, Researchers from the University of Chicago compared the indwelling and retrieval complications of Denali and Celect filters placed in the infrarenal IVC. This retrospective review was conducted over 2 years and included 171 Denali and 162 Celect filters. 91% (303) of the filters were placed from a jugular approach. Follow-up CT images were evaluated in 58 filters from each group. The Denali group showed significantly lower incidence of caval strut penetration (1 vs 12) and tilt (1 vs 15). Retrieval attempts were made on 43 Denali filters and 53 Celect filters with similar indwelling times. There was significantly less fluoroscopy time in the Denali group (3.1 vs 6.0 min). In addition, there was a trend toward fewer “complex” retrievals in the Denali group (2 vs 10, p = 0.06). ​Complex retrieval was defined as “successful retrieval attempts in which conventional retrieval techniques, failed necessitating one of the adjunctive retrieval methods described earlier.” It is noted that only 5 of the 15 tilted Celect filters presented for retrieval and 3 of those 5 required snare-over-guide wire loop technique or forceps for retrieval. Complex retrievals were associated with increased fluoro time (14.3 vs 3.2 min) and increased dose (333.4 vs 149.5 mGy).

Discussion


While the current study demonstrates that “complex” techniques are needed more frequently in retrieval of Celect filters when compared with Denali filters, it remains to be seen if this will significantly impact practice pattern. “Complex” retrievals are becoming much less, well.… complex. Given increased familiarity with advanced techniques, many centers are seeing a marked decrease in fluoro times for even the most challenging retrievals. When combined with overall decreasing rates of strut penetration and tilt (even in the Celect group), the result is low average rates of fluoroscopy time when compared to the group as a whole (Celect 6.0 min in the current study). Further, depending on local pricing, there is likely an increased cost for Denali when compared to some of the older generations of IVC filters. Before a practice considers changing filters, a comprehensive view of potential costs (clinical and financial) of retrieval should be thoroughly considered.



Click here for abstract

Bos AS, Tulius T, Patel M, Leef JA, Navuluri R, Lorenz JM, Van Ha TG. Indwelling and retrieval complication of Denali and Celect infrarenal vena cava filters. J Vasc Interv Radiol. June 2016. doi: 10.1016/j.jvir.2016.03.034

Post Author:
Luke R. Wilkins, MD
University of Virginia

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