Search

Background: Iatrogenic migration of inferior vena cava (IVC) filters is a potentially life-threatening complication that can arise during blind insertion of central venous catheters when the guide wire becomes entangled with the filter. In this study, we reviewed the occurrence of iatrogenic migration of IVC filters in the literature and assessed methods for preventing this complication. Methods: A literature search was conducted to identify reports of filter/wire entrapment and subsequent IVC filter migration. Clinical outcomes and complications were identified. Results: A total of 38 cases of filter/wire entrapment were identified. All of these cases involved J-tip guide wires. Filters included 23 Greenfield filters, 14 VenaTech filters, and one TrapEase filter. In 18 cases of filter/wire entrapment, there was migration of the filter to the heart and other central venous structures. Retrieval of the migrated filter was successful in only four of the 18 cases, and all of these cases were complicated by strut fracture and distant embolization of fragments. One patient required resuscitation during retrieval. Successful disengagement was possible in 20 cases without filter migration. Conclusions: Iatrogenic migration of an IVC filter is an uncommon complication related to wire/filter entrapment. This complication can be prevented with knowledge of the patient's history, use of proper techniques when placing a central venous catheter, identification of wire entrapment at an early stage, and use of an appropriate technique to disengage an entrapped wire. [Copyright &y& Elsevier]

Purpose: To evaluate the retrievability and safety of the G2 filter. Materials and Methods: A retrospective study of all G2 filter retrievals at a single institution was conducted. Hospital records and imaging studies were reviewed for complications, and factors affecting retrieval were analyzed. Results: From 2005 to 2009, a total of 139 patients presented for retrieval of their G2 filter, and 131 pairs of pre- and post-placement cavagrams and 39 computed tomography scans were available for analysis. The following findings were recorded: limb penetration (n = 33), tilt greater than 15° (n = 22), local migration greater than 2 cm (n = 17), retained thrombus within the filter (n = 16), deformity (n = 10), inferior vena cava (IVC) occlusion (n = 3), fracture (n = 2), and pulmonary embolism breakthrough (n = 2). A total of 118 filters were removed, with a mean indwelling time of 131.8 days (range, 3–602 d). Indwell time (< 90, 90–180, or > 180 d) did not affect retrieval (P = .4). There were 21 filters (15.1%) left in situ as a result of severe tilt (n = 9), significant thrombus in the filter (n = 5), IVC occlusion (n = 3), filter incorporation into the caval wall (n = 3), or lack of central venous access (n = 1). There was a strong relationship between penetration and caudal migration (P < .0001). Severe tilt was associated with prolonged fluoroscopic times for retrieval (P = .003). Conclusions: The majority of G2 filters can be removed without difficulty. The most common factor affecting retrieval was severe tilting. The indwelling time had no impact on retrieval. G2 filter–related complications were frequent but most, including fractures, were clinically insignificant. [ABSTRACT FROM AUTHOR]

• We develop two splitting algorithms for finding a zero of the sum of three monotone operators, one of which is assumed to be Lipschitz continuous. • Each iteration of these algorithms require one forward evaluation of the Lipschitz continuous operator and one resolvent evaluation of each of the other two operators. • The inspiration for the proposed algorithms arises from interpretations of the reflected splitting algorithms as discretisations of the continuous-time proximal point algorithm. In this work, we propose and analyse two splitting algorithms for finding a zero of the sum of three monotone operators, one of which is assumed to be Lipschitz continuous. Each iteration of these algorithms require one forward evaluation of the Lipschitz continuous operator and one resolvent evaluation of each of the other two operators. By specialising to two operator inclusions, we recover the forward-reflected-backward and the reflected-forward-backward splitting methods as particular cases. The inspiration for the proposed algorithms arises from interpretations of the aforementioned reflected splitting algorithms as discretisations of the continuous-time proximal point algorithm. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To report the occurrence of fracture of the Recovery filter and incidence of potentially life-threatening complications associated with fractured fragment migration. Materials and Methods: A retrospective study of images obtained after placement of Recovery inferior vena cava (IVC) filters from 2003 to 2006 was conducted at a single tertiary-care center. Images were reevaluated for fracture and migration; complications related to filter fracture were investigated. Kaplan–Meier survival analysis was performed to investigate the relationship between time in situ and fracture. Results: A total of 363 Recovery filters were placed; 97 were retrieved, leaving 266 filters in situ (135 patients subsequently died of other causes). The following images were evaluated: 130 chest computed tomography (CT) scans, 153 abdominal CT scans, 254 chest radiographs, 148 radiographs of the abdomen/pelvis, and 106 cavagrams. Mean imaging follow-up interval was 18.4 months (maximum, 81.3 mo). No en bloc migration occurred outside the IVC. Twenty-six limb fractures (all short limbs) were identified in 20 patients; the earliest occurred at 4.1 months. Eight fragment migrations occurred into pulmonary arteries, seven into iliac/femoral veins, one into the right ventricle, and one into the renal vein. Seven fragments were intracaval near the filter, one was extracaval, and one could not be located. Kaplan–Meier survival estimates predicted a fracture rate of 40% at 5.5 years. Of the 20 patients with filter fractures, three died of unrelated causes and 17 remain asymptomatic. Conclusions: Recovery filter fractures occurred at the short limb only, with a suggested 5.5-year fracture risk of 40%. No life-threatening events occurred in patients with filter fracture. [Copyright &y& Elsevier]